Summary: Mrs X complained the Council failed to provide timely care for Mr Y when his needs increased. She said the Council delayed assessing Mr Y and delayed increasing his care package. The Council was at fault for delays putting Mr Y’s second care call in place. It agreed to waive some of Mr Y’s arrears and pay a symbolic financial remedy in recognition of the distress and financial impact its fault had.

The complaint

1. Mrs X complained the Council failed to provide timely care for Mr Y when his needs increased. She said the Council delayed assessing Mr Y and delayed increasing his care package. This meant Mr Y had to self-fund his care on two occasions, the first occasion lasting about seven months.
2. Mrs X said the Council did not take this into consideration when carrying out Mr Y’s financial assessment and asked him to contribute more to the cost of his care. This resulted in Mr Y not having enough money to cover his basic needs and some expenses linked to his disability.
3. Mrs X would like the Council to reduce Mr Y’s contribution to the cost of his care to reflect the time he was paying for care privately.

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The Ombudsman’s role and powers

4. 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)
5. 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

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

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What I found

Assessment of needs

8. 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.
9. Councils must carry out assessments over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Councils should tell people when their assessment will take place and keep them informed throughout the assessment.
10. 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.

Direct payments

11. 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.

Charging for social care services

12. A council has a duty to arrange care and support for those with eligible needs, and a power to meet both eligible and non-eligible needs in places other than care homes. A council can choose to charge for non-residential care following a person’s needs assessment. Where it decides to charge, the council must follow the Care and Support (Charging and Assessment of Resources) Regulations 2014 and have regard to the Care Act statutory guidance. (Care Act 2014, section 14 and 17)
13. Where a council has decided to charge for care, it must carry out a financial assessment to decide what a person can afford to pay. It must then give the person a written record of the completed assessment. A council must not charge more than the cost it incurs to meet a person’s assessed eligible needs.
14. People receiving care and support other than in a care home need to keep a certain level of income to cover their living costs. Councils’ financial assessments can take a person’s income and capital into consideration, but not the value of their home. After charging, a person’s income must not reduce below a weekly amount known as the minimum income guarantee (MIG). This is set by national government and reviewed each year. A council can allow people to keep more than the MIG. (Care Act 2014)

What happened

15. I have summarised below some key events leading to Mrs X’s complaint. This is not intended to be a detailed account of what took place.
16. Mr Y has poor mobility and uses a Zimmer frame to mobilise. His daughter, Mrs X, and granddaughter help with personal care, housework, laundry, and shopping.
17. Mr Y has a package of care and support arranged using a direct payment from the Council. Initially in 2021, the Council decided Mr Y needed a 45 minute care call in the morning to help with personal care, breakfast, and medication.
18. Mrs X telephoned the Council on 14 December 2021 about another assessment for Mr Y. The Council confirmed Mr Y was on the list for an assessment but could not say when this would be. The Council noted Mr Y was going to the toilet independently, feeding himself, heating food, and walking unaided with a frame. Mr Y had one care call a day, but Mrs X said he was struggling with lunch and evenings. She wanted his care package to be reviewed as she felt his needs had increased.
19. The Council did not consider Mr X needed an urgent assessment. It noted it only closed his case in September 2021 and could not see information to suggest increased care needs. The Council was not allocating non urgent cases until the New Year, due to winter pressure and prioritising hospital discharges.
20. Mrs X telephoned the Council on 25 January 2021 seeking an urgent review of Mr Y’s care package as he was not coping with one visit per day. Mrs X said she had been calling the Council for the past four months asking for an increase in Mr Y’s care. She said Mr Y needed urgent support in the afternoon, evening, and medication administration before going to sleep.
21. The Council visited Mr Y on 4 February 2022 with Mrs X present. It noted Mr Y lived on his own and needed assistance with his meal preparation, washing and dressing. His daughter and granddaughter took it in turns completing his shopping, housework, and meal preparation. The Council considered Mr Y would benefit from a bedtime call as he struggled to get himself ready for bed. It needed to complete an assessment, however.
22. The Council completed an assessment of Mr Y’s needs on 18 March 2022. It noted Mrs X could not continue to support Mr Y in the evening with meal preparation and personal care due to work. It considered Mr Y would benefit from a 45 minute care call in the evening for help with meal preparation, personal care, changing into nightwear, and assisting him to bed due to poor mobility.
23. The Council’s outcome forum considered the request for increased support on 22 March 2022. The forum decided to defer its decision. That was because Mr Y’s assessment was showing as incomplete and there was no support plan. It said it would reconsider the request when mandatory work was completed.
24. The Council telephoned Mrs X to tell her the outcome on 23 March 2022.
25. Mrs X telephoned the Council for updates in April and June 2022. The Council said it would look into things.
26. The Council wrote to Mr Y on 12 May 2022 after completing a financial assessment. It calculated Mr Y must contribute £69.28 a week towards the cost of his care going from April 2022. Previously, Mr Y contributed £60.45 a week.
27. The Council completed another assessment of Mr Y’s needs on 13 June 2022. The content of this assessment is the same as the March 2022 assessment, with the Council again considering Mr Y would benefit from a 45 minute evening care call.
28. The Council’s outcome forum considered the request for increased support again on 28 July 2022. It agreed Mr X could have an additional 45 minute evening call due to a decline in his mobility.
29. Mrs X telephoned the Council on 21 February 2023 seeking another assessment for Mr Y. She said his needs had increased. Mrs X told me she first asked the Council for another assessment in January 2023 when he became incontinent. However, I saw no record of this.
30. The Council visited Mr Y on 15 March 2023 with Mrs X present. Mrs X struggled to visit Mr Y every lunchtime to assist with meal preparation. She also said carers had to double up in the morning as Mr Y is very stiff and it takes them an hour to help him. Mrs X said she had to pay carers extra for this from her own pocket. She wanted carers to assist Mr Y with lunchtime calls. The Council said Mr Y need an Occupational Therapist (OT) assessment before the case can go before its outcome forum. It also advised Mrs X to discuss Mr Y’s poor mobility with the community physiotherapist who already visited Mr Y.
31. Mrs X emailed the Council requesting an urgent OT assessment.
32. Mrs X telephoned the Council on 16 March 2023 asking to speak to a manager to change Mr Y’s allocated worker.
33. An OT spoke to Mr Y and Mrs X on 17 March 2023. They wanted to speak to Mr Y’s carers for an idea of his needs and whether double handed care is necessary. They did not want to increase mobility aids at the risk making Mr Y dependent or cause a decline in his current abilities. They said the OT service had high demand and did not have capacity to assess Mr Y immediately. The OT asked Mrs X for details of Mr Y’s care agency and physiotherapist.
34. Mrs X’s local Member of Parliament wrote to the Council on her behalf on 20 March 2023, asking the Council to increase Mr Y’s care package. They said Mr Y’s carers felt four, one-hour daily visits were now appropriate for Mr Y’s needs, as he was struggling with his mobility and incontinence. They also said the Council had informed the family there were more urgent cases taking priority, and Mrs X was concerned Mr Y’s health was deteriorating. They asked the Council to prioritise Mr Y’s case.
35. The OT spoke to Mr Y’s care agency on 20 March 2023. The agency explained one carer visits twice a day but usually stays an hour instead of 45 mins to meet Mr Y’s needs. The OT suggested Mr Y may benefit from more frequency of care to improve his mobility. The care agency agreed.
36. The OT then spoke to Mr Y’s social worker. The social worker awaited feedback from Mr Y’s physiotherapist about single or double handed care. They told the OT Mr Y’s family currently self-fund a second carer in the morning and evening, as well as a lunchtime call. The OT agreed contact Mr Y’s physiotherapist about double or single-handed care, put Mr Y on the waiting list for an urgent assessment for possible double handed care.
37. The OT spoke to Mr Y’s physiotherapist on 21 March 2023. The physiotherapist wanted to see Mr Y again with Mrs X present. They agreed Mr Y would benefit from increase of care to support mobility, but were cautious about Mr Y needing two people to assist with personal care in standing. The physiotherapist said Mr Y’s long-term goal was to mobilise outdoors again, and he was making good progress with exercises and confidence.
38. Mr Y’s social worker spoke to the physiotherapist on 27 March 2023. The physiotherapist had not assessed Mr Y as needing two carers. They were looking at falls prevention and to give Mr Y exercises. Mr Y wore continence pads and was told not to mobilise when carers are not present. PA will be moving in with his daughter soon.
39. The social worker visited Mr Y the same day to complete an assessment of his needs. Mrs X and the physiotherapist were present. The social worker recommended increasing Mr Y’s care, but did not identify need for double-handed care.
40. On 3 April 2023, Mr Y’s social worker asked the care agency to send timesheets as evidence of the extra time carers spent with Mr Y. The care provider sent this information.
41. The social worker emailed Mrs X on 17 April 2023 advising they were still reviewing Mr Y’s timesheets from the care provider, as there were discrepancies making it difficult to verify how long carers spent with Mr Y.
42. The social worker spoke to the care agency on 20 April 2023. The care agency said Mr Y often needed double-handed care, but this is unpredictable. He had three or four falls since December and sometimes cannot get off the bed without the help of two people. If the first carer cannot assist Mr Y to meet his needs they will call for a second carer. Mr Y’s daughter was often there to help the carer when needed. Mr Y can be down in the morning, so things take longer. The care agency said it came out of company funds if the carer must stay longer. The social worker was concerned the second carer did not always record their visit, and the rationale for needing the second carer was not clear.
43. The care agency sent the Council Mr Y’s timesheets for that month on 25 April 2023.
44. The Council’s outcomes forum met the same day to consider the request for Mr Y to have three care calls a day. The forum agreed to increase Mr Y’s care package. This was to be made up of 45 minutes in the morning, 30 minutes at lunchtime, and 45 minutes in the evening via direct payment.
45. Mr Y’s social worker telephoned Mrs X to tell her the forum approved a lunchtime call, starting from 26 April 2023. They said any further increase would need to be assessed by the OT.
46. The Council wrote to Mr Y on 15 May 2023 after completing a financial assessment. It calculated Mr Y must contribute £107.35 a week towards the cost of his care going forwards. It allowed Mr Y a personal allowance of £214.35. It disregarded £13.85 for water rates and £10 for disability related expenses.
47. Mr Y complained to the Council about his financial assessment on 24 May 2023. He said his personal allowance only increased by £5.29 and does not cover the cost of his bills and expenses linked to his disability. He therefore cannot afford to pay the contribution of £107.35. He said his care needs increased, and he had to pay for extra care himself before getting more funding, due to the Council’s delays. He explained this in the financial assessment paperwork, but the Council did not take it into account.
48. The Council’s financial assessment team responded on 14 July 2023. It explained the minimum income guarantee, and how it calculated Mr Y’s contribution by looking at his income and disability related expenses.
49. Mr Y complained to the Council about his financial assessment again on 6 September 2023. He said he outlined his current situation, but the Council did not take it into account. He said his care was delayed by eight months, so he had to pay for a second carer visit himself, which is why he asked the Council to increase his personal allowance. He said he could not afford to pay his assessed charge of £107.35 a week. The previous year he only paid £69.28. He also said his third care call was delayed by three months and he again had to fund this himself. Mr X said he was now incontinent and needed a fourth daily care visit so could not afford the increased contribution.
50. The Council’s financial assessment team responded to Mr Y’s complaint on 6 October 2023. It said it looked into the extra paid care Mr Y had from February 2023 for his incontinence needs. It said it spoke to Mr Y's social worker who confirmed incontinence needs should be met with pads and the three daily visits Mr Y already had. It said it could not allow these additional costs as disability related expenditure.
51. Mr Y was not satisfied with the Council’s response. He complained delays with the Council’s assessments resulted in him having to seek private care.
52. The Council responded to Mr X’s complaint on 8 August 2024. It upheld his complaint about significant delay implementing the requested increase of care for Mr Y’s evening call following contact by his family in December 2021. It said Mr Y’s request for more funding was considered in March 2022, but the Council needed more information. Unfortunately, this process did not happen until July 2022. It said that while Mr Y states he sought private care in the meantime, he did not present this as an issue at the time. The Council said if he had done so it would have considered this. The Council apologised for the delay and said it would endeavour to be timelier in future.
53. The Council did not uphold Mr Y’s complaint about delays assessing his increased needs in March 2023.
54. Mr Y remained dissatisfied with the Council’s response. He said it upheld his first complaint but did not address the issue of him having to self-fund his second care call. He reiterated the stress the Council’s delays caused him and his family, and the financial impact it had on them.
55. The Council sent its final complaint response on 27 December 2024. However, its findings did not change.

My investigation

56. Mrs X told me Mr Y’s first care call started in August 2021, within four weeks his assessment.
57. Mrs X requested a second care call in December 2021. The Council assessed Mr Y in February 2022, but the second care call did not start until July 2022.
58. Mrs X said the family paid for Mr Y’s second care call themselves from December 2021 until July 2022. This was for one hour in the evenings and cost £11 per hour. They did not notify the Council of this.
59. The Council increased the financial contribution Mr Y had to pay towards the cost of his care in April 2022. He was unable to pay the extra amount, and his account went into arrears. At this point Mrs X said she told the Council about the period they paid for Mr Y’s care privately and asked why his contribution increased.
60. Mrs X said the family asked for another assessment in December 2022 when Mr Y became incontinent. The same social worker visited but did not do a proper assessment. Mrs X asked for a new social worker and the Council assigned someone to complete an assessment in March 2023.
61. The family paid privately for a third and fourth care call from December 2022 as they were not prepared to let Mr Y stay in soiled nappies. Mr Y had a third care call funded by the Council from April 2023.
62. The Council told me its records showed Mrs X made telephone calls in October 2021 and January 2022 seeking an increase in Mr Y’s care. The Council allocated the case on 28 January and started assessing Mr Y on 4 February. Its outcome forum discussed the request on 22 March but deferred making a decision as it needed more information. The case went back to the forum on 22 July, and it agreed an extra care call. The Council said there was a slight delay due to staff sickness.
63. The Council reallocated Mr Y’s case on 24 March 2023 and completed another assessment. Its outcome forum agreed to increase Mr Y’s care calls on 25 April. He had three calls a day, 45 minutes in the morning, 30 minutes at lunchtime, and 45 minutes in the evening. This was funded via direct payment.
64. The Council said it did not recall Mr Y’s family telling it about them paying for additional care calls privately and found no record of this. The family mentioned private care when they asked for the cost to be disregarded as part of the financial assessment process.

Analysis

65. Mrs X asked the Council to assess Mr Y in late 2021 as she said his needs increased. The Council did not do so until March 2022. However, it did consider the request, but decided it was not urgent because it had only closed Mr Y’s case in September 2021 and it did not consider there was evidence his needs had increased. On the evidence seen, there was no fault in the Council’s approach here.
66. The Council’s outcome forum could not reach a decision on whether to increase Mr Y’s care plan following the assessment in March 2022. The Council told me that was because the forum needed more information. On the evidence seen, the Council did complete an assessment of Mr Y’s needs in March 2022, recommending an evening care call. That was before the outcome forum meeting. Unfortunately, it is not clear what further information the outcome forum needed. Additionally, on the evidence seen, the Council then took no further action until it assessed Mr Y again in June 2022, three months later. That was fault.
67. The Council’s outcome forum agreed Mr Y could have an evening care call in July 2022. That was based on an assessment completed in June 2022. However, I saw no difference in the Council’s assessment of Mr Y’s needs from the June assessment compared to its earlier assessment in March. The Council’s assessment of Mr Y’s needs in March 2022 had already concluded he would benefit from an evening care call, and since there is no evidence of any material change between the March assessment and the June assessment, on balance I consider Mr Y should have had the evening care call in place by the end of March 2022. That was four months earlier than the additional care call actually started. That was fault. During this time, Mr Y’s family were paying for an extra care call from their own money. This caused distress and impacted the family financially.
68. Mrs X told me she asked the Council to assess Mr Y again in January 2023. The Council’s records show Mrs X made the request in February 2023. Not only was Mrs X asking for another care call, at lunchtime, but she also said Mr Y needed double-handed calls. I found the Council met with Mr Y and Mrs X in March 2023 and then made suitably prompt enquiries about Mr Y’s needs with the care agency, physiotherapist and OT. It presented Mrs X’s request to its outcome forum in April 2023 and approved a lunchtime call to start straight away. I did not see any evidence of fault or delay in the Council’s consideration of Mrs X’s request on that occasion. While I appreciate Mrs X had already started to pay the care agency for an extra care call from her own pocket, the Council had to properly consider and assess Mr Y’s needs before agreeing to fund an additional care call.
69. In Mrs X’s email exchanges with the Council about arrears on Mr Y’s direct payment account, she raises the fact Mr Y paid for his own care while waiting for the Council to re-assess him. She also highlighted this was due to the Council’s delays. She wanted the Council to take this into account when calculating Mr Y’s contribution towards the cost of his care. The Council said it could not do this. Unfortunately, the Council only considered an additional care call the family was funding at the time of the request. That was a fourth daily call which the Council considered Mr Y did not need. The Council did not consider the fact Mr Y’s family had been funding a second call in 2022, which was later approved after delays by the Council.
70. When the Council approved the second care call it paid Mr Y a direct payment of £179 per week. That equates to £89.50 a week for each 45-minute care call. £89.50 a week for the period between 22 March 2022 and 28 July 2022 (18 weeks) totals £1,611. That is the amount of direct payments Mr Y missed out on due to the Council’s delay.
71. Mr Y’s account with the Council for the contributions he must make towards the cost of his care is currently in significant arrears. The Council will therefore waive £1,611 of the debt, which is consistent with the outcome Mrs X sought when she asked the Council to factor this in when calculating Mr Y’s contribution towards the cost of his care.

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Agreed Action

72. Within four weeks of my final decision, the Council should:
• Apologise to Mr Y and pay him £200 in recognition of the avoidable distress caused by its delays in initially increasing his care package, which Mr Y had to fund himself, causing financial hardship.
• Waive £1,611 of Mr Y’s arrears for contributions towards the cost of his care and support package.
73. The Council should provide us with evidence it has complied with the above actions.

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Final Decision

74. I found the Council at fault for delays putting Mr Y’s second care call in place. The Council should waive some of Mr Y’s arrears and pay a symbolic financial remedy in recognition of the distress and financial impact its fault had.

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Investigator's decision on behalf of the Ombudsman