Summary: Ms C complains the Council has not assessed her care needs properly and Council commissioned care agencies were inadequate. There was no significant injustice caused by the care agencies commissioned by the Council and no fault in the Council’s decision to reduce services.

The complaint

1. Ms C complains the Council has failed to meet her needs and the Council commissioned care agencies, Radis Community Care, “Radis”, and Aston Home Care Limited, “Aston”, provided an inadequate service.
2. Because of these failures Ms C says her health has worsened as she cannot meet her care and support needs. Ms C says she has also had the frustration of dealing with the Council and care agencies when things have gone wrong.

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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. We investigate complaints about councils and certain other bodies. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, sections 24A(1)(A) and 25(7), as amended).
5. When considering complaints we make findings based on the balance of probabilities. This means that we look at the available relevant evidence and decide what was more likely to have happened.
6. We provide a free service, but must use public money carefully. We do not start or continue an investigation if we decide:

• there is not enough evidence of fault to justify investigating, or
• any fault has not caused injustice to the person who complained, or
• any injustice is not significant enough to justify our involvement, or
• we could not add to any previous investigation by the organisation, or
• further investigation would not lead to a different outcome, or
• there is no worthwhile outcome achievable by our investigation.

(Local Government Act 1974, section 24A(6), as amended, section 34(B))

7. 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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What I have and have not investigated

8. 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 has done. (Local Government Act 1974, sections 26B and 34D, as amended)
9. I have considered matters from 30 August 2023. This is when the Council reassessed Ms C and confirmed its decision that Ms C was eligible for five and a quarter hours per week. I have not looked at issues prior to this point as there is no reason why Ms C could not have come to us before. Ms C has the support of an advocate and the issues are now too long ago to properly investigate.
10. The law says we cannot normally investigate a complaint unless we are satisfied the organisation knows about the complaint and has had an opportunity to investigate and reply. However, we may decide to investigate if we consider it would be unreasonable to notify the organisation of the complaint and give it an opportunity to investigate and reply. (Local Government Act 1974, section 26(5), section 34(B)6)
11. I have therefore not investigated matters from 3 July 2024 as these complaints were not part of Ms C’s complaint to the Council. If Ms C has not already done so she can raise any matters from this date with the Council. Ms C should however be mindful of paragraph 8 and the timescales for escalation to the Ombudsman.

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How I considered this complaint

12. I considered evidence provided by Ms C and the Council as well as relevant law, policy and guidance.
13. Ms C and the Council had an opportunity to comment on a draft decision. I considered any comments made before reaching a final decision.

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What I found

What should have happened

Assessment

14. 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

15. 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

16. 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.

What happened

17. Ms C lives independently in her own home. She has several health difficulties which affect her ability to manage her personal and domestic care tasks. The Council provided Ms C with a personal budget and commissioned care from care agencies. In November 2022 the Council reduced Ms C’s care package. Ms C was unhappy with the Council’s decision and over the next year the Council reviewed Ms C’s needs and offered a reablement service in addition to her assigned personal budget.
18. In March 2024 Radis provided support to Ms C. Ms C complains Radis did not provide an adequate service. In particular:
1. Care workers attended the property without identification, “ID”, the key safe code, gloves or an apron. Radis disputes care workers visited without ID as it provides all care workers with ID and it completes spot checks. Radis says the Council provided it with the wrong key code. The Council says Ms C does not allow care workers entry without gloves or an apron so care workers would not have provided support to Ms C without this equipment. It accepts it provided Radis with the wrong keycode, but officers rectified this quickly.
2. Radis sent a male care worker who Ms C refused entry to. Radis says the Council did not say care workers needed to be female, and it only sent a male care worker once and then amended Ms C’s support plan.
3. Care workers did not come at agreed times. Ms C says the calls need to be time specific because of her medication. Radis says the care plan did not record the calls need to be time specific. Care workers therefore have a 30-minute window either side of the call time to support Ms C. After seeking advice from a pharmacist, the Council did not assess Ms C needed a time specific call although this would be her preference. In response to a draft decision statement, Ms C says the pharmacist told the Council one medicine was not time specific but the Council did not consider the other medication she was taking. Ms C says the pharmacists are supportive of Ms C having timed calls for medication.
4. Ms C says she is not getting nutritious meals as care workers focus on salads, which are quick to prepare, rather than a hot cooked meal. Radis says there is no evidence this is the case. On Thursdays’ care workers make a meal and a salad for later. Care workers have an hour to do this.
5. Care workers share information about other people who live nearby and therefore may share information about Ms C. Radis disputes this but says on one occasion Ms C asked about a person they support and why their care was delivered before hers. Radis said they do not share information.
19. Radis said it could not meet Ms C’s demands and withdrew its service. Aston became involved in June 2024. Ms C complains Aston is ill equipped to provide care to vulnerable people and complained that:
1. it asked Ms C to put a large QR code on her front door;
2. care workers photographed prescription information which they shared and discussed in a What’s App group;
3. care workers pay 40% of their wages to their drivers;
4. care workers are afraid of their managers and ask clients not to report them;
5. care workers have inadequate training about how to provide personal care.
20. Aston responded to these complaints saying:-
1. it had removed the QR code from the front door to indoors;
2. it accepted that it had taken pictures and used them to add to the care plan, but had deleted them;
3. it did not elaborate on transport arrangements but said this was a matter for individual care workers who all have different travel arrangements;
4. it encourages all care workers to ask for help when needed. Aston provides regular training, team meetings, supervision and spot checks to ensure properly trained staff.
21. On 3 July Aston said it could no longer provide a service and withdrew support. In August the Council reassessed Ms C’s needs. The assessment involved both Ms C and her advocate; the social worker also sought information from a pharmacist
22. Ms C’s second complaint is about how the Council has assessed her, in particular it:-
1. relied on information from a previous assessment which contained inaccurate information. Ms C asked for a new social worker and assessment. The Council did not consider the assessment flawed but because of the passage of time it assigned Ms C a new social worker to complete a care review;
2. unnecessarily asked for consent to contact the GP – the Council responded saying it needed formal consent from Ms C as she had previously changed her mind;
3. emailing Ms C several times a day with repeated requests for information which caused Ms C distress as her advocate is not always available to support her. The Council says there were two occasions when an officer contacted Ms C four times and another two occasions when they emailed three times in a day. The Council says it needed this contact to inform Ms C’s assessment and asked Ms C if there was a preferable alternative form of contact;
4. had previously assessed Ms C as needing six hours of Personal Assistant (PA) support for weekly community-based activities such as shopping. The Council says although it originally assessed Ms C as needing this support it no longer felt this was necessary as Ms C was accessing the community and shopping without support. In response to a draft decision Ms C says the Council did not tell her this and she continues to have difficulties with shopping.

Was there fault causing injustice?

23. The Council accepted some things went wrong. This includes providing a male care worker on one occasion and the use of a QR code without discussing its position with Ms C. While these would have caused Ms C some inconvenience, I consider this was limited and I cannot say they caused Ms C significant injustice.
24. I would however suggest through contract monitoring the Council reviews Aston’s policy about the use of QR codes and personal phones for taking photos, and reminds officers and Radis about including people’s preferences when discussing how services are provided.
25. I have considered the other complaints made against the care providers and do not intend to investigate these further. This is because:
• further investigation would not result in a worthwhile outcome because the complaint involves two versions of events, one from Ms C and the other from the care agency. Without independent evidence, and as I cannot favour one account over another, it would be difficult to make a balance of probability finding. This relates to complaints at paragraph 18 (a), (d) and (e);
• the complaints did not cause Ms C any, or limited injustice 18(a), (e), 19 (a) to (d);
• further investigation would not lead to a different outcome. Ms C has several difficulties which can make managing her daily life challenging. While I understand Ms C was disappointed with the services provided and they did not meet what she considers to be her needs, the Council is only under a duty to meet assessed eligible needs not Ms C’s preferences or what she considers to be her needs. There was no evidence to suggest Ms C needed a time specific call to take her medication or that care workers were ill equipped to meet Ms C’s needs. This relates to complaints 18(c) and 19(e).
26. The Ombudsman cannot challenge a professional judgement unless there is procedural fault in the way the Council has reached decisions. My role is to consider whether there was any procedural fault in the way it assessed Ms C for services and how it reached decisions, taking into account what the law and statutory guidance says it should do.
27. In response to a draft decision statement Ms C says the Council failed to properly consider medical evidence as part of the assessment. The Council is entitled to evaluate medical information it is provided and reach its own conclusions about how it applies to a person’s eligibility and need for services. I find no fault in how the Council assessed Ms C. The Council:-
• completed an evidence based assessment – while I am aware Ms C does not agree with the Council’s evaluation of information it received, the Council considered Ms C’s comments, medical information she provided, and reviewed this against other sources of information such as a pharmacist;
• completed a person centred assessment – Ms C took part in her assessment and she also had the benefit of an advocate through the assessment process;
• amended the assessment following comments from Ms C.
28. Ms C has complained the Council relied on information from a previous assessment to inform its decision making. I have not considered this further as Ms C has had several opportunities to inform the assessment with the help of an advocate. I therefore do not consider it would be proportionate or there would be any worthwhile outcome to consider this further. If Ms C feels there is wrong or missing information from the assessment she can raise this with the Council and provide the amendments required.

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Decision

29. There is no fault in the actions of the Council.
30. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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Investigator's decision on behalf of the Ombudsman