Summary: Mr X complained about the way the Council assessed his care needs and decided to meet them. We found fault which caused injustice to Mr X. The Council has already taken some action to remedy Mr X’s injustice. The Council has also agreed to apologise to Mr X, address his concerns about the most recent care and support plan, decide whether to carry out a carer’s assessment for Mr X’s mother and pay him £500 to recognise his distress. The Council has also agreed further service improvement.

The complaint

1. Mr X complains about inadequate care arrangements made by the Council for him in 2024. He says the Council:
• failed to carry out his care needs assessment in spring 2024;
• failed to assess his Occupational Therapy (OT) needs in spring 2024 and used outdated OT information in his care needs assessment and care plan;
• issued inadequate care plan for him in July 2024 and subsequently included incorrect information in the Continuing Healthcare (CHC) checklist;
• failed to communicate with him effectively.
2. Mr X says the Council’s failings caused him significant distress, which resulted in further deterioration of his health. He spent much time writing emails and complaining.

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The Ombudsman’s role and powers

3. 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)
4. 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)
5. 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)
6. We investigate complaints about councils and certain other bodies. We cannot investigate the actions of bodies such as National Health Service (NHS) or of individual members of staff. (Local Government Act 1974, sections 25 and 34(1), as amended)
7. 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.
8. 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

9. I have not investigated anything that happened after the beginning of October 2024, when the Council prepared its stage two response to Mr X’s complaint. As explained in paragraph five any new complaint issues would need to be raised with the Council first.
10. I have not investigated parts of Mr X’s complaint which refer to the individual members of staff as we can only investigate councils and certain other bodies.
11. I have not investigated the CHC process. Complaints about NHS CHC are dealt with by the Parliamentary and Health Service Ombudsman.

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How I considered this complaint

12. I considered evidence provided by Mr X and the Council as well as relevant law and guidance.
13. Mr 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

Law and guidance

Care needs 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.
15. 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.
16. During the assessment, local authorities must consider all of the adult’s care and support needs, regardless of any support being provided by a carer. Where the adult has a carer, information on the care that they are providing can be captured during assessment, but it must not influence the eligibility determination. After the eligibility determination has been reached, if the needs are eligible or the local authority otherwise intends to meet them, the care which a carer is providing can be taken into account during the care and support planning stage. The local authority is not required to meet any needs which are being met by a carer who is willing and able to do so, but it should record where that is the case. (Care and Support Statutory Guidance paragraph 6.15)

Care plan

17. 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.
18. 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.

Carer’s assessment

19. Where the adult providing care under contract or through voluntary work is also providing care for the same adult outside of those arrangements, the council must consider whether to carry out a carer’s assessment for that part of care they are providing informally. (Care and Support Statutory Guidance paragraph 6.17)

What happened

20. This section is not a full account of everything that happened but an outline of events which are relevant to this decision.
21. Mr X has a progressive, long-term medical condition. Mr X’s mother came to live with him and started providing care to him from the early 2021.
22. After Mr X’s return from abroad, at the beginning of February 2024 Mr X’s social worker (Social Worker 1) visited him at home. They discussed Mr X’s deteriorating health and his mother’s needs. Mr X’s mother could not continue providing him with 24/7 care due to her own health needs. Mr X explained he needed support to engage more with community activities. Social Worker 1 explained the process of completing the Care Act assessment.
23. At the beginning of March 2024 Mr X asked the Council for an OT to visit him urgently as he had been waiting for the OT support for two months.
24. A month later Mr X was referred to the Community Reablement Team (CRT). In mid-April an independent care assistant visited Mr X and found out:
• Mr X’s mother was providing him 24-hour care;
• several medical letters stated Mr X needed 24-hour care;
• Mr X was receiving direct payments for a personal assistant (PA). He did not think it was enough to cover his care needs;
• Mr X had an appointment booked with a Speech and Language therapist to review his swallowing;
• CRT was not suitable service for Mr X’s needs.
25. In the third week of April 2024 Social Worker 1 called Mr X to discuss his choking risk and a CHC checklist, following which Social Worker 1 issued Mr X’s care needs assessment document. Social Worker 1 did not get Mr X’s medical records from his GP.
26. Mr X requested for his correspondence to be passed to the head of Adult Social Care (ASC). Mr X asked for a new senior social worker, senior OT and for the Council to formally register his complaint.
27. The Council allocated an OT (OT1) and a senior OT (OT2) as well as a senior social worker (Social Worker 2) to Mr X.
28. In the third week of May OT2 visited Mr X and discussed outstanding OT actions with him. In the correspondence that followed Mr X specified some outcomes which OT2 missed. A few days later OT2 referred Mr X to a minor works team.
29. At the end of May an Investigating Officer held a meeting with Mr X to discuss his complaint. The Council responded to the complaint in the second week of June.
30. After Mr X’s meeting with the ASC Assistant Director and the Investigating Officer the Council sent him a revised investigation report and its revised response. The Council upheld or partially upheld all issues of the complaint. The Council recommended:
• completing care needs assessment for Mr X as a matter of urgency;
• reminding ASC staff that Care Act assessments must be completed in a timely manner and a copy of the assessment sent to the service user;
• completing outstanding OT actions;
• arranging a multi-disciplinary team meeting to agree a package of care and ensure clear understanding of funding streams;
• reminding staff to keep channels of communication open even if there are no updates;
• considering withdrawing Mr X’s mother from his package of care due to her own needs;
• for all staff to read the Recording Policy.
31. In the second week of June 2024 OT1 carried out an assessment of Mr X’s OT needs.
32. Social Worker 2 contacted Mr X and arranged a meeting in mid-June 2024 to review his care and support needs. Following this meeting Social Worker 2 issued a revised care assessment document, which was referring to the recent OT involvement although it also quoted the OT assessment carried out in September 2023. OT1 and OT2 were mentioned among the parties involved in completing the assessment.
33. At the end of July 2024 Social Worker 2 issued Mr X’s care and support plan.
34. In mid-August 2024 Mr X complained about the inadequate care package. He said the care plan referred to the outdated OT report from September 2023 and the Council failed to consult his General Practitioner (GP).
35. At the beginning of October 2024 the Council’s Executive Director responded to Mr X’s complaint. She confirmed the Council’s care needs assessment and care plan were correct. The Director explained some of Mr X’s needs for support should be funded by the NHS and suggested carrying out a CHC assessment for Mr X.

Analysis

36. When assessing Mr X’s needs in spring 2024 the Council should have:
• explained the assessment process to Mr X;
• consulted with the OT team as Mr X’s specifically asked for the OT involvement;
• obtained Mr X’s medical records.
37. Following Mr X’s complaint the Council apologised to Mr X and took action to remedy his injustice. Specifically the Council:
• allocated OT1 and OT2 to Mr X. OT2 visited Mr X at home and OT 1 carried out an assessment of his needs;
• changed Mr X’s social worker from Social Worker 1 to Social Worker 2;
• issued a revised care needs assessment document for Mr X;
• involved Mr X in the assessment process.
38. Although OT1 and OT2 were involved with Mr X since May 2024, they seemed to focus on adaptations and equipment rather than an assessment of Mr X’s OT needs to verify the content of his care needs assessment. The OT assessment report finalised in December 2024 did not inform the content of Mr X’s care and support plan of July 2024. Because of the progressive nature of Mr X’s condition updating his physical needs was particularly important and Mr X kept asking for it.
39. In its response to Mr X’s complaint the Council accepted it had failed by not obtaining his GP records. Despite this, when revising Mr X’s care and support plan Social Worker 2 still failed to get these records.
40. After receiving his new care and support plan of July 2024 Mr X pointed out many errors and inaccuracies in the document. The Council failed to address them. The Council should have checked Mr X’s requests for amendments with the professionals involved in supporting Mr X and decide whether the document needed to be amended.
41. In the revised care and support plan of July 2024 the Council explained it would not carry out a carer’s assessment for Mr X’s mother as she was a paid carer. The Council was aware, however, that Mr X’s mother was also providing him also with informal care. As pointed out in paragraph 19 of this decision the Council should have considered whether to carry out a carer’s assessment for Mr X’s mother rather than claim she was ineligible.
42. The Council’s failings listed above are fault. They caused injustice to Mr X as he was frustrated by the incomplete assessment of his needs. He was not happy with the outcomes of the assessment and considered the Council’s failings might have affected them. Mr X spent much time corresponding with the Council about his care needs assessment and care and support plan and was increasingly frustrated by the Council not addressing his concerns. Taking into account Mr X’s state of health the Council’s failings are likely to have affected him more than they would have affected other service users without progressive illness.
43. We cannot say, even on the balance of probabilities, what the Council would have decided if it had considered whether to carry out a carer’s assessment for Mr X’s mother. Applying a blanket policy rather than making an individual decision about a carer’s assessment for Mr X’s mother caused Mr X uncertainty and further confusion. Trying to understand the Council’s position Mr X spent much time contacting external organisations, where he sought support.

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Action

44. To remedy the injustice caused by the faults identified, we recommend the Council complete within 20 working days of the final decision the following:
• apologise to Mr X and Mr X’s mother for the injustice caused to them by the faults identified. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The Council should consider this guidance in making the apology I have recommended;
• address in writing Mr X’s concerns, if any, about the description of his needs in the most recent care and support plan prepared for him;
• decide whether to carry out a carer’s assessment for Mr X’s mother. The Council will provide Mr X and us with its decision;
• pay Mr X £500 to recognise the distress caused to him by the Council’s failings found in this investigation.

The Council will provide the evidence that this has happened.

45. We also recommend the Council within three months of the final decision:
1. remind social workers who carry out care needs assessments for people with complex health needs of the importance of getting medical information to inform the content of their care and support plans;
2. ensure its front-line staff and team managers in the ASC teams which carry out care needs assessment review this decision.

The Council should provide us with evidence it has complied with the above actions.

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Decision

46. I find fault causing injustice. The Council has accepted my recommendations, so this investigation is at an end.

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Investigator's decision on behalf of the Ombudsman