Summary: There was fault in the way the Council assessed Mrs C’s needs for care and support. This meant that it is not certain what the outcome of the assessment would have been if the fault had not happened. The Council has agreed to apologise, pay a symbolic financial remedy and carry out a service improvement.

The complaint

1. Ms B complains on behalf of her mother, Mrs C. Ms B says the Council decided Mrs C’s care plan without properly considering Mrs C’s needs, the views of Mrs C and her family, the level of care Ms B provided to Mrs C and the fact that Ms B was not able to continue to provide care.

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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. 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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How I considered this complaint

4. I have discussed the complaint with Ms B. I have considered the evidence provided by Ms B and the Council, the relevant law, policy and guidance and both sides’ comments on the draft decision.

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What I found

Law, policies and guidance

5. The Care Act 2014, the Care and Support Statutory Guidance 2014 and the Care and Support (Charging and Assessment of Resources) Regulations 2014 set out the Council’s duties towards adults who require care and support and its powers to charge. The Council also has its own policies.

Assessment of needs and care plan

6. The threshold for eligibility is based on identifying how a person’s needs affect their ability to achieve relevant outcomes, and how this impacts on their wellbeing. Council must consider whether:
• The adult’s needs arise from a physical or mental impairment or illness.
• As a result of the adult’s needs the adult is unable to achieve 2 or more of the specified outcomes.
• As a consequence of being unable to achieve these outcomes there is a significant impact on the adult’s wellbeing.
7. The outcomes are:
• Managing and maintaining nutrition
• Maintaining personal hygiene
• Managing toilet needs
• Being appropriately clothed
• Being able to make use of the home safely
• Maintaining a habitable home environment
• Developing and maintaining family or other personal relationships
• Accessing and engaging in work, training, education or
• Making use of necessary facilities or services in the local community
• Carrying out caring responsibilities for a child.
8. The CASS Guidance says
• In addition to taking all reasonable steps to agree how needs are to be met, the local authority must also involve the person the plan is intended for, the carer (if there is one), and/or any other person the adult requests to be involved. 
• The person, and their carers, will have the best understanding of how the needs identified fit into the person’s life as a whole and connect to their overall wellbeing. They are well placed to consider and identify which care and support options would best fit into their lifestyle and help them to achieve the outcomes they identified during the assessment process. 

Needs met by a carer

9. In considering the person’s needs and how they may be met, the local authority must take into consideration any needs that are being met by a carer. The person may have assessed eligible needs which are being met by a carer at the time of the plan – in these cases the carer must be involved in the planning process.
10. Provided the carer remains willing and able to continue caring, the local authority is not required to meet those needs. However, the local authority should record the carer’s willingness to provide care and the extent of this in the plan of the person and also the carer, so that the authority is able to respond to any changes in circumstances (for instance, a breakdown in the caring relationship) more effectively. 

Agreeing the plan

11. The plan should be person-centred, with an emphasis on the individual having every reasonable opportunity to be involved in the planning to the extent that they choose and are able.
12. Consideration of the needs to be met should take a holistic approach that covers aspects such as the person’s wishes and aspirations in their daily and community life, rather than a narrow view purely designed to meet personal care needs.
13. When developing the plan, there are certain elements that must always be incorporated in the final plan. These are:
• the needs identified by the assessment
• whether, and to what extent, the needs meet the eligibility criteria
• the needs that the authority is going to meet, and how it intends to do so
• for a person needing care, for which of the desired outcomes care and support could be relevant
• for a carer, the outcomes the carer wishes to achieve, and their wishes around providing care, work, education and recreation where support could be relevant
• the personal budget
• information and advice on what can be done to reduce the needs in question, and to prevent or delay the development of needs in the future
• where needs are being met via a direct payment, the needs to be met via the direct payment and the amount and frequency of the payments
14. The local authority must take all reasonable steps to agree with the person how the person’s needs will be met in the care plan, before the authority signs off the plan.
15. Wherever possible, local authority sign-off should occur when the person and the local authority have agreed on the plan, including the final personal budget amount, and how the needs in question will be met.
16. If the plan cannot be agreed with the person, or any other person involved, the local authority should state the reasons for this and the steps which must be taken to ensure that the plan is signed-off.
17. If a dispute still remains, and the local authority feels that it has taken all reasonable steps to address the situation, it should direct the person to the local complaints procedure. However, by conducting person-centred planning and ensuring genuine involvement throughout, this situation should be avoided.
18. Upon completion of the plan, the local authority must give a copy of the final plan to the person for whom the plan is intended, any other person they request to receive a copy.

Carer’s assessment

19. Where somebody provides or intends to provide care for another adult and it appears the carer may have any needs for support, the council must carry out a carer’s assessment. A carer’s assessment must seek to find out not only the carer’s needs for support, but also the sustainability of the caring role itself.
20. The carer’s assessment must also consider the outcomes that the carer wants to achieve in their daily life, their activities beyond their caring responsibilities, and the impact of caring upon those activities. This includes considering the impact of caring responsibilities on a carer’s desire and ability to work and to partake in education, training or recreational activities, such as having time to themselves. This impact should be considered in both a short-term immediate sense but also the impact of caring responsibilities over a longer term, cumulative sense.

Financial assessment

21. Councils must carry out a financial assessment if they decide to charge for the care and support. This will assess the person’s capital and income.

Capital

22. The upper capital limit is currently set at £23,250 and the lower limit at £14,250. A person with assets above the upper capital limit will have to pay for their own care. Those with capital between the upper and the lower limit will make a contribution known as ‘tariff income’ from their capital.

12 week-disregard

23. An important aim of the charging framework is to prevent people being forced to sell their home at a time of crisis. The regulations under the Care Act 2014 therefore create space for people to make decisions as to how to meet their contribution to the cost of their eligible care needs. A local authority must therefore disregard the value of a person’s main or only home for 12 weeks in the following circumstances:
• (a) when they first enter a care home as a permanent resident
• (b) when a property disregard other than the 12-week property disregard unexpectedly ends because the qualifying relative has died or moved into a care home

Deferred payment agreement

24. A deferred payment agreement is an agreement with the Council that allows a person to defer paying for their care costs until a later date, when their home is sold or they pass away. The Council will place a legal charge on the property to ensure the debt is repaid.

Council’s complaint procedure

25. The Council complaints procedure says the Council will respond to complaints within 15 working days at stage 1 and 20 working days at stage 2.

What happened

26. Mrs C is an older woman who has health conditions and a diagnosis of dementia. She lived in a retirement flat which she owned. Ms B provided most of the care to Mrs C but Mrs C also went to a day centre on Monday and Friday and agency care workers provided care on Tuesday, Wednesday and Sunday.
27. Ms B contacted the Council on 2 February 2024 and asked the Council to assess Mrs C’s care needs as she was concerned that Mrs C could no longer live at home and should move into a care home. The plan was for Mrs C to move into the care home on 29 February 2024. Ms B said Mrs C owned the retirement flat so she would sell this and be able to self-fund the care home fees for a while.
28. Mrs C moved into a care home on 29 February 2024 for a four-week trial period.
29. Ms B emailed the Council on 9 March 2024 as Mrs C had still not been assessed.
30. The case was allocated to a social worker on 12 March 2024. The social worker rang Ms B and asked what the funding arrangements were. Ms B explained that Mrs C’s capital was below £23,250 but Mrs C intended to sell her flat in the future and then she would have money to self-fund her placement. The social worker said that, as the arrangement was in place, Mrs C did not need an assessment. Ms B said she wanted the social worker to carry out the assessment as she wanted a professional opinion on how to best meet Mrs C’s needs.
31. The social worker visited Mrs C on 13 March 2024 and assessed her needs for care and support.
32. Mrs C explained to the social worker that she had a package of care at home which consisted of two visits a day. The care workers helped Mrs C with getting up and washing, cooking, providing lunch and cleaning. Mrs C said Ms B also provided support but she needed more support and it was ‘not fair’ on Ms B anymore.
33. The social worker asked Mrs C why she did not increase the care package at home. Mrs C said she started having support at home after she had a fall in the bath, but she did not like waiting for care workers and she was not happy with the agency. The social worker said Mrs C could change to a different agency.
34. The social worker concluded that Mrs C’s needs could be met in the community with an increased package of care. She told Mrs C that this was the outcome of her assessment and therefore the Council would not fund her placement and it would be ‘her choice if she wishes to remain but would be self-funded.’ The social worker said she would contact Ms B and let her know what the outcome of the assessment was.
35. The social worker rang Ms B to discuss the outcome of the assessment. Ms B disagreed with the outcome and said:
• Mrs C had diabetes but was not able to make meals and was not drinking enough. Mrs C was having hallucinations, which the doctors said may be linked to the diabetes not being managed well. She was seeing colours and was speaking to the cushions. She thought her walker was a mother and baby.
• Mrs C was unable to wash and dress herself and was wearing clothes inside out.
• Mrs C struggled with letting the care workers into the building. There was a buzzer to let people in but 99% of the time Mrs C pressed the wrong button and set off the alarm which went through to the call line.
• Mrs C had had several falls.
• Ms B supported Mrs C with making meals, doing the washing, personal care, shopping, paying bills and everything to support her. She was supporting Mrs C every day but she also worked full time.
36. The social worker’s note of the conversations said she ‘discussed what I have discussed with [Mrs C]’. She said:
• Mrs C could have changed her care agency.
• She could increase the care agency’s visits.
• Assistive technology such as a falls detector or a sensor mat could assist with the falls.
• Mrs C’s needs could therefore be met at home and the Council would not fund the placement.
37. Ms B disagreed and said she would appeal the decision. She said it was not fair on her or her work and on the family. She said she needed a carer’s assessment. She asked whether the Council would agree to provide a deferred payment agreement but the social worker said it would not agree to this as Mrs C could go home with a package of care.
38. The social worker rang Ms B on 14 March 2024 and said: ‘I have made the recommendations as discussed but I will contact [the Agency] as they supported [Mrs C] at home to gather more information.’
39. Ms B provided more information about Mrs C. She said that before Mrs C was on medication, she would wander the halls and ring Mrs C at 5:00 am because she did not know where she was. She said Mrs C was then given medication and did well for two years, but was now starting to have hallucinations again. Ms B had asked the doctor to increase the medication, but the doctor said Mrs C was on the maximum dose. Ms B said Mrs C was ‘going downhill rapidly’ and the social worker had seen her on the best day.
40. Ms B’s sister, Ms D emailed the Council on 14 March 2024 to complain about the assessment. She said:
• Mrs C had rapidly declining mobility, incontinence, memory loss, hallucinations, inability to feed or dress herself, diabetes and sight loss and high risk of falls, but the social worker had said she could live at home with a package of care.
• Mrs C was unable to manage the technology to open the door to carers.
• Ms B had to be on call day and night but she worked full time, had a family to care for and had her own debilitating health conditions.
• How could the Council have made its decision without a carer’s assessment of Ms B?
• Ms B and Ms D also had caring duties for their brother who had his own needs for care and support and safeguarding. The impact of this should also be considered when the Council decided how Ms B was able to continue to manage providing care to Mrs C in a ‘very dangerous situation’.
• Mrs C was too vulnerable to live at home and the impact on Ms B was too great. Ms D was concerned about Ms B’s mental and physical health. Mrs C had a flat she could sell but in the meantime Mrs C needed a deferred payment agreement so she could pay the fees.
41. The social worker spoke to the Agency’s manager on 14 March. The manager said the Agency visited on three days. The Agency provided support with taking medication, preparing meals and drinks, monitoring Mrs C and reporting concerns, washing dishes and emptying bins. The Agency did not provide personal care to Mrs C and did not support her in her toilet needs. She said there had been two occasions when there was a problem with the care workers accessing the building.
42. The social worker spoke to Ms B on 18 March and said her assessment remained unchanged. Ms B questioned how the social worker could have completed the assessment of Mrs C without completing Ms B’s carer’s assessment. The social worker said she had considered information from the care home, Mrs C and the Agency and her recommendation was the same. The social worker said she would make a referral for a carer’s assessment but it could take 28 days to be allocated. Ms B said she would appeal the assessment as it had not been completed correctly.

Assessment of Mrs C’s needs – 19 March 2024

43. The assessment of Mrs C said Mrs C needed support in 6 of the 10 outcomes:
• Nutrition. Mrs C needed support to prepare meals. She could eat and drink independently but needed help cutting up her food and sometimes used a spoon. She had diabetes so needed support with her diet.
• Personal hygiene. Mrs C needed support from one carer with personal care.
• Being appropriately clothed. Mrs C needed support with putting on her clothes and choosing weather appropriate clothes.
• Habitable home environment. Mrs C needed support with changing bed sheets, laundry and household tasks.
• Being able to use the home safely. Mrs C used a walking stick and rollator. She had a lifeline (an alarm system that calls for help when a person has had a fall or needs help) at home and assistive technology could be offered if she lived at home.
• Making use of the community. Mrs C used a wheelchair if she left the house so she needed support to go out in the community.
44. The conclusion was that Mrs C could be supported at home with a package of care of four visits a day and assistive technology such as a falls detector and sensor mat. Mrs C attended a day centre two days a week and this could also be increased.
45. A different social worker explained to Ms B on 8 April 2024 that, as Mrs C continued to live at the care home, a carer’s assessment was not needed, but if Mrs C returned to live at home, then the carer’s assessment would be carried out.
46. Ms B and Ms D sent an email to the social worker on 9 May 2024 and said:
• Mrs C was not able to let care workers in the building.
• What assistive technology was the Council proposing as Mrs C was not able to use the simplest of technology?
• How would the plan prevent falls? The problem at home was that Mrs C would not eat, even when care workers visited. This led to hallucinations and confusion, with Mrs C walking around confused and disoriented. She needed to be in a place where her nutrition and liquid intake was monitored.
• Ms B still did not have a carer’s assessment. Ms B was due to change jobs and would no longer have the flexibility she previously had in providing care to Mrs C. She had taken 17.5 hours of carer’s leave in the 10-12 weeks before Mrs C went to the care home. This was in addition to the daily and weekend visits.
• Ms B had discussed her mental health with her GP. The huge stress of being a carer had taken a toll on her mental health in addition to the stress of losing her job and the stress on her family.
• The family wanted the Council to provide the 12 week disregard and a deferred payment agreement until Mrs C’s property was sold.
• Until the social worker had visited Mrs C’s home, assessed Mrs C’s needs as a carer and re-assessed Mrs C’s physical and mental health which were declining, the assessment had not been fully completed.
• Ms D said Mrs C could now barely walk and she did not see how assistive technology could prevent falls.
47. The social worker replied and said her position was unchanged. Ms B continued to raise concerns about the assessment of Mrs C in the following weeks.
48. The social worker visited Mrs C on 25 June 2024. The social worker spoke to Mrs C, Ms B and Ms D. Mrs C said she wanted to stay at the care home and said she ‘feels like shooting herself’ when the social worker discussed returning home. Mrs C said she had two falls last week and her back hurt although she had not informed anyone of the falls.
49. The social worker observed Mrs C walking with a stick from the chair in her room to the toilet and said she had not seen a change in Mrs C.
50. The family said they were being ‘gaslighted’ and ‘penalised’ and that they were not listened to. The family wanted the 12-week disregard for Mrs C but the social worker said her position was unchanged and Mrs C was not eligible therefore for a 12-week disregard.
51. The social worker sent an email to Ms B on 4 July 2024 and said she had considered the further information from 25 June 2024 and reviewed the care plan but her assessment remained unchanged. Mrs C’s needs could be met in the community, she did not need 24-hour care and she did not qualify for financial assistance. The social worker said she would close her involvement. She had raised the family’s concerns with her manager and, if the family wanted to discuss this further, they should contact the manager.

Assessment – 4 July 2024

52. The social worker completed the assessment of Mrs C’s needs for care and support which was, essentially the same assessment from March 2024 copied and pasted in its entirety but she added two paragraphs about the visit on 25 June 2024.

Further assessments – July 2024

53. The manager decided on 5 July 2024 that an occupational therapist (OT) should assess Mrs C to ‘complete home visit to support to return home.’
54. The Council also asked an agency (agency 1) which provides assistive technology to visit Mrs C’s home to decide if any technology could assist Mrs C in answering the door. Agency 1 visited the home and said there was no technology that could assist.

OT assessment – 26 July 2024

55. The OT assessed Mrs C and visited Mrs C at her home and then at the care home. The OT said:
• The purpose of the home visit was to assess/observe Mrs C in her home and to discus with Mrs C and her daughters their thoughts and wishes regarding where Mrs C should live.
• A family approach to the assessment was significant as Mrs C’s current and future care and support needs could impact on the family. Ms B and Ms D’s concerns were integral to the assessment process.
• Ms B worked full time and admitted the care provision for Mrs C was becoming unmanageable and as a result the carer strain was having significant impact on Ms B’s mental and emotional health and wellbeing.
• Ms B and Ms D said Mrs C did not eat the food prepared by the care workers when she was at home. As Mrs C had diabetes, appropriate nutrition was vital and poor nutritional intake had a significant impact on Mrs C’s physical and cognitive functioning. Ms B and Ms D were concerned that Mrs C become more disorientated, especially during the night and was experiencing increased falls.
• Before Mrs C moved to the care home, she had 3 morning calls and 4 lunch calls. She went to a day centre twice a week but Mrs C said these sessions were full days and she found this very physically and mentally tiring.
• Mrs C admitted there had been a marked deterioration in her cognitive and physical functioning.
• Both the care home staff and Ms B and Ms D raised concerns if Mrs C returned home. Mrs C suffered with anxiety and could become disorientated and anxious, particularly at night. Mrs C had falls sensors and supervision with her mobility in all communal areas at the care home due to her falls risk.
• Mrs C was independent with all transfers but access to the toilet during the night would be a concern due to Mrs C’s unsteady mobility.
• Mrs C’s mobility was unsteady which a shuffling/festinating gait. This type of gait was often adopted to avoid falling. The care home and Mrs C’s daughters had noted that Mrs C’s mobility had deteriorated over the past months. The OT said Mrs C had a high risk of falling. Mrs C frequently reached out for support when mobilising and presented with ‘poor dynamic balance.’
• The OT said Mrs C was previously able to allow carers into the property as she was able to mobilise more steadily. However, given Mrs C’s current presentation, she would struggle to safely get to the front door to allow the care workers in. There was no assistive technology that could help Mrs C in this regard.
56. The OT concluded as follows:
• If Mrs C returned home, there was a very high change the care may breakdown which would exacerbate carer strain on the family causing significant impact on the health and wellbeing for the family and Mrs C.

Assessment – 13 August 2024

57. The social worker completed a further assessment of Mrs C’s needs on 13 August 2024 and said that Mrs C’s needs could be met at the care home.

Complaint – 23 August 2024

58. Ms B complained to the Council on 23 August 2024. I have summarised the complaints. Ms B said:
• The initial assessment of Mrs C in March 2024 was completed without speaking to Mrs C’s family or the care agency which supported Mrs C.
• Even after the family and the care agency were contracted, the March assessment still did not fully take account of the concerns that the family had raised or represented the support that Ms B provided to Mrs C when she was living at home.
• The family was excluded from the care planning. The family only received the March assessment during the meeting on 25 June 2024, four months after it was completed. The family was not informed that a care plan had been completed so they did not have the chance to comment on the plan.
• The social worker said technology would assist in meeting Mrs C’s needs if she lived at home but did not explain how the needs would be met by technology.
• The family had been consistently ignored and requests for support by a 12-week disregard and a deferred payment agreement declined. It took four months for the Council to obtain a second professional opinion and to change its position.
• There was a delay in carrying out a carer’s assessment of Ms B.
• The second assessment dated 4 July 2024 did not properly consider Mrs C’s needs as the social worker said there was no change in Mrs C and the assessment was almost identical to the first assessment. It was only after the occupational therapist carried out her assessment that the social worker changed her position.
• The Council did not follow its complaints procedure.

Council’s response – October and November 2024

59. The Council responded on 1 October and 7 November 2024 and said:
• It apologised that the family had not received a copy of Mrs C’s assessment and care plan in a timely manner and had not been given the opportunity to comment.
• The social worker completed her assessment in March and gathered information from the care agency, the day centre and the care home, but concluded that Mrs C did not require 24-hour residential care.
• The Council was sorry if the family felt excluded from the care planning. Mrs C was able and willing to participate in the assessment and did not object that there was no family representation. The social worker rang Ms B before visiting Mrs C (for the first assessment) and informed Ms B of the outcome of the assessment.
• It was sorry that Ms B felt that Mrs C’s needs had not been fully captured in the early assessments.
• The social worker was not made aware of the festinating gait until the OT identified this. The social worker contacted the care home and the GP and they did not alert the social worker to the festinating gait.
• The Council agreed to backdate the 12-week disregard to 26 July 2024.

Further information

60. After the 12-week disregard ended, the Council continued to pay the fees under a deferred payment agreement. Mrs C’s property is being rented out to a tenant.
61. I asked the Council how a falls detector or sensor mat could have prevented a fall, if Mrs C was living at home. The Council said that these devices did not prevent falls, but reduced the risks from delayed assistance.

Analysis

62. I have explained to Ms B that the Ombudsman cannot carry out an assessment of Mrs C’s needs or say what her care plan should have been. I can only consider whether there was any fault in the way the Council made its decisions. I have done so by comparing what the Council should have done, according to the law, guidance and policies with what the Council did.
63. To summarise, the Council had a duty to:
• Assess Mrs C’s needs, putting Mrs C’s wishes at the centre of the assessment and including Mrs C’s carers (her family) in the assessment.
• If care was provided by a family carer, the assessment and care plan should say what needs the carer was meeting and whether the carer was willing and able to continue to provide the care.
• Take all reasonable steps to agree the care plan with Mrs C, before it was signed off.
• Send a copy of the assessment and care plan to Mrs C or Ms B.
• Refer Mrs C and her family to the complaints process if the care plan could not be agreed.
64. I uphold the complaint that the social worker initially completed her assessment of Mrs C’s needs and made the decision that Mrs C’s needs could be met at home before talking to the family or the care agency so there is fault in that respect. Ms B was Mrs C’s main carer so it is difficult to see how the Council could decide that Mrs C’s needs could be met in the community without knowing what needs Ms B was currently meeting, the hours of support she was providing and whether she was still able and willing to do so.
65. The social worker then rang Ms B later that day to inform her of the outcome of the assessment. Ms B strongly disagreed with the social worker’s assessment during that conversation.
66. I accept that the social worker then had further conversations with Ms B and the care agency but I am of the view there is still further fault regarding the March assessment/care plan.
67. I have firstly considered the care plan itself. I note that the Council does not prepare a separate needs assessment and care plan document but provides a combined document called ‘conversation record.’ That is not an issue in itself but, in my view, the document did not include all the information it should have done and there is fault in that respect.
68. For example, one of the family’s main concerns was that Ms B could no longer provide the level of care she was providing.
69. The March assessment included one paragraph about the support Ms B provided. There was no detail on how many hours support Ms B provided, how frequently Ms B provided support, how often she was on standby, how often she was called out in an emergency and so on.
70. More importantly, there was no detail on how much support Ms B would still be expected to provide to Mrs C after the new care plan was implemented. Nor did the document say whether Ms B was able or willing to provide the support. Clearly the family interpreted the proposed plan to say that Ms B would still provide a lot of support but, as this was never clarified in the document, it was impossible to say.
71. I also uphold the complaint that the care plan did not fully explain how technology would address the risks to Mrs C that the family had identified, particularly relating to disorientation linked to poor nutrition, falls and difficulties with the door entry system. These problems meant that Ms B was permanently ‘on call’ to deal with the emergencies that happened and this problem was not resolved by the four visits a day.
72. The Council later admitted that there was no technology that could address the door opening problems or reduce the risk of falls. Therefore, I agree the care plan did not fully explain how the risks would be addressed.
73. Finally, the Council failed to send the assessment or care plan to Mrs C or Ms B once it was completed and this was fault. The failure to send the document meant that the family did not know what the actual plan was and was therefore unable to properly comment on the plan. This was particularly important in a case such as this one where the social worker knew that the family strongly disagreed with the plan.
74. In terms of the carer’s assessment, the Council has already apologised for the failure to provide the carer’s assessment and I agree this was fault.
75. I also think that the Council may be confusing two issues here. I agree there should have been a carer’s assessment of Ms B, but that would focus on Ms B’s needs as a carer and whether she needed a care plan in her own right. The information the family wanted related to the level of support Ms B provided to Mrs C and whether she was willing and able to continue to do so. This information should have been included in Mrs C’s care plan, as I have explained in paragraphs 70 and 71.
76. I have also considered the assessment dated 4 July 2024. I agree with Ms B that this was, in essence the same assessment from March 2024. And this was in contrast with the OT assessment which was carried out on 7 August 2024.
77. I appreciate that a social worker is not an OT, so the social worker could not have diagnosed the shuffling/festinating gait, but I do note that some of the information that the OT relied upon was information that the social worker should have considered.
78. These were the views and wishes of the family and Mrs C, the unsustainability of the caring role for Ms B and the impact this had on her, the deterioration that the care home, Ms B and Ms D had noticed in Mrs C, the fact that Mrs C was permanently supervised when she mobilised in the care home because of the risk of falls. So I can understand why Mrs C and the family felt that they were not heard until the OT carried out the assessment where they were put at the centre of the assessment process.
79. The Council has already upheld the complaint that its complaint response was late and I agree this was fault. Ms B and Ms D complained in August and the Council did not respond until October and November, outside of the time limits set within its own policy.

Injustice and remedy

80. I have considered what injustice Mrs C and her family suffered as a result of the fault I identified. Although there was fault in the way the assessment process was conducted, I cannot say what the outcome of the assessments would have been, if the fault had not happened. I also note that the Council agreed to pay for the fee during the 12- week disregard period. Therefore, the injustice is the uncertainty that the outcome may have been different if the fault had not happened.
81. The Ombudsman can sometimes agree a small symbolic payment where the injustice is distress through uncertainty. I do not underestimate the stress Mrs C and Ms B suffered during the months that they tried to obtain the full assessment that they had sought from the beginning. I therefore recommend the Council pays them £150 as a symbolic remedy.

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Action

82. The Council has agreed to take the following actions within one month of the final decision. It will:
• Apologise to Mrs C, Ms B and Ms D in writing for the fault I have identified.
• Pay Ms B and Mrs C £150 each for the distress caused by the fault.
• Remind the relevant staff of the importance to consider the needs that are being met by a carer and to include whether the carer is able and willing to continue to meet those needs.

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Decision

83. I have completed my investigation and found fault by the Council. The Council has agreed the remedy to address the injustice.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman