Summary: Mrs Y complained the Council failed to account for relevant evidence in its decisions about Mr X’s care and support. Mrs Y also complained the Council moved Mr X to a new residential care setting without considering his best interests; incorrectly decided Mr X’s housing benefit (HB) entitlement; and failed to consider a complaint about Mr X’s care assessment. We found the Council at fault for avoidable delay in approaching its funding panel for additional resources. We cannot say this led to Mr X’s first placement breaking down, but believe Mrs Y experienced avoidable frustration and uncertainty. We have not found the Council at fault for how it accounted for Mr X's best interests when considering a move. We have found some fault with how the Council scheduled the best interests meeting and how it communicated with Mrs Y about Mr X’s transition. We found the Council at fault for being unable to confirm it had registered Mrs Y’s HB concerns as an appeal, and for failing to consider Mrs Y’s escalated complaint. The Council has agreed to apologise, review Mr X’s care and support plan, and pass Mrs Y’s HB appeal to the Tribunal.

The complaint

1. On behalf of Mr X, Mrs Y complained:
1. The Council failed to properly assess Mr X’s care needs and take account of relevant information in its decision-making between October 2023 and October 2024.
2. The Council made Mr X move from one accommodation setting to another at short notice, without regard for his best interests, in October 2024. The Council failed to properly plan and coordinate this move.
3. The Council incorrectly decided Mr X was not entitled to housing benefit or financial assistance in his new accommodation, leading to financial arrears.
4. The Council failed to update Mr X’s care and support needs assessment, or provide a copy on request. The Council then refused to consider a complaint about this.
2. Mrs Y said the Council's actions caused both her and Mr X avoidable distress, frustration and uncertainty. She also said the Council's actions led to a deterioration in Mr X’s wellbeing and caused avoidable risks to his safety.

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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. 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.
5. The law says we cannot normally investigate a complaint when someone has a right of appeal, reference or review to a tribunal about the same matter. However, we may decide to investigate if we consider it would be unreasonable to expect the person to use this right. (Local Government Act 1974, section 26(6)(a), as amended)
6. 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

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

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Relevant legislation, guidance and policy

Assessment

9. 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.
10. 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.

Best interest decision making

11. A key principle of the Mental Capacity Act 2005 is that any act done for, or any decision made on behalf of a person who lacks capacity must be in that person’s best interests. The decision-maker also has to consider if there is a less restrictive choice available that can achieve the same outcome. Section 4 of the Act provides a checklist of steps decision-makers must follow to determine what is in a person’s best interests.
12. If there is a conflict about what is in a person’s best interests, and all efforts to resolve the dispute have failed, the Court of Protection might need to decide what is in the person’s best interests.

Housing Benefit appeals

13. If someone disagrees with a housing benefit decision they can ask the council for a review. If they have a review, and are not happy with the decision, they can then appeal to the tribunal. The law says people should appeal within one month of the date of the decision they think is wrong. Because the person can appeal, we would normally decide not to investigate complaints about these decisions.

Ombudsman’s role

14. The Ombudsman’s role is to review how councils have made decisions, in the course of performing their duties. We may criticise a council if, for example, it has not followed an appropriate procedure, not considered relevant evidence, or not properly explained the reason it has made a decision. We call this ‘fault’, and, where we find it, we can consider the consequence of the fault and ask the council to address this.
15. But we do not provide a right of appeal against a council’s decisions, and we cannot make operational or policy decisions on a council’s behalf. If a council has acted without fault, then we cannot criticise it, even if a complainant feels strongly that its decision is wrong. We cannot uphold a complaint on the grounds someone disagrees with what a council has done.

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What I found

Key events

16. Below is a summary of the relevant key events. It does not detail every exchange between parties. Where necessary, I have expanded on some of these events in the “analysis” section of this decision statement.
17. In May 2022, the Council carried out the care needs assessment for Mr X, who then lived at home with his family and attended a daily care setting five days per week. The assessment concluded Mr X’s significant care needs would best be met in a residential care setting.
18. Mr X undertook a lengthy transition to move from the family home into Placement 1, a setting commissioned by the Council. This transition took place from mid-2022 to late 2023, with Mr X formally moving into Placement 1 in October 2023.
19. As part of this transition, the Council reduced Mr X's attendance at the day centre from five days per week to three days per week, as Placement 1 was expected to provide on-site care activities. The Council said it maintained three days’ attendance at the day centre, to account for Mr X’s presenting needs. The Council said it also funded additional care hours for Mr X, which Placement 1 could use flexibly when Mr X did not attend the day centre. On weekends, Mr X stayed with his family. Mrs Y told the Ombudsman she was concerned by these changes, but was assured the Council would revisit this decision if needed.
20. In December 2023, the Council, Mrs Y and Placement 1 reviewed Mr X’s care arrangements. The report said Mr X had adjusted well. However, Mr X showed some challenging behaviours. Due to changes in the family home, Mr X would also be unable to return home on weekends. The Council agreed in principle to seek funding for additional care and support. Mrs Y told the Council Mr X’s challenging behaviours had increased because of the reduction in day centre attendance.
21. In January 2024, Placement 1 asked the Council to fund extra care hours for Mr X, including weekends. Placement 1 also provided examples of Mr X’s challenging behaviour. The Council said it wanted to review whether Placement 1 was still meeting Mr X’s needs. Mrs Y asked the Council to focus on supporting Mr X at Placement 1, rather than considering a move.
22. The Council sought advice from health professionals on ways Placement 1 could communicate with Mr X to help manage his behaviour. It said it would seek extra funding once Placement 1 tried and assessed these interventions. Mrs Y told the Council communication interventions were separate from care needs. She said Mr X needed more support. The Council said it would present the case to its funding panel as soon as possible.
23. In February 2024, Placement 1 raised a safeguarding alert about Mr X's challenging behaviour. Placement 1 said the Council should consider if alternative settings would be beneficial.
24. In late March 2025, the Council told Mrs Y it had asked Placement 1 to submit proposals for additional support for Mr X. In early April, Placement 1 asked for funding for weekend care and two more days for Mr X at the day centre. The Council asked Placement 1 for more details so it could make a case.
25. In late April 2024, Placement 1 told the Council Mr X's challenging behaviour had not improved. It said even with additional funding, it did not think it was suitable for Mr X’s needs. It said the Council should review Placement 1's suitability.
26. Between May and July 2025:
• The Council sought input from health professionals on whether Placement 1 was suitable for Mr X. Placement 1 said Mr X's behaviour had not improved.
• Mrs Y sought a meeting with the Council, Placement 1 and health professionals to discuss Mr X’s case, highlighting the Council had not sought more funding as it had said it would.
• The Council said health professionals needed to observe Mr X in different settings to better understand the cause of his behaviour. The Council said Placement 1 no longer appeared suitable for Mr X and was not meeting his needs. The Council asked Mrs Y to consider exploring new settings.
• Mrs Y said moving Mr X was not in his best interests. She said the Council should increase his support at Placement 1.
27. In August 2024, the Council took Mr X’s case to its funding panel. The Council agreed to increase Mr X’s day centre attendance back to five days temporarily, while it looked at potential new placements. Mrs Y viewed multiple potential settings, but told the Council none were suitable.
28. In September 2024, the Council told Mrs Y it needed to hold a best interests meeting, to consider the families views, as well as the views of Placement 1 and health professionals. It said health professionals had suggested a new setting, Placement 2. The Council said Placement 2 had been asked to assess Mr X.
29. The following day, the Council told Mrs Y it was bringing the meeting forward, to the next working day. It said this was due to the impact of Mr X's behaviour on himself and other residents. Mrs Y said this was too short notice, as she needed time off from work.
30. On 16 September 2024, the Council held the best interests meeting. In attendance were Mrs Y, Placement 1 and health professionals. The Council concluded Placement 1 was no longer suitable for Mr X due to escalating risks, environmental limitations, limited staff skill, and unsuccessful behaviour management strategies. The Council decided Mr X needed an alternative local placement, with more space and experienced staff.
31. Later in the month, the Council told Mrs Y Placement 2 could meet Mr X’s needs. Mrs Y agreed Placement 2 could be suitable, providing Mr X had appropriate support and day centre attendance.
32. On 29 September 2024, Mrs Y complained to the Council. Mrs Y complained the Council tried to move Mr X without increasing support at Placement 1, despite changes in Mr X's behaviour being foreseeable and preventable. Mrs Y also complained about the timing and conduct of the best interests meeting, which she said skewed facts and focused on reducing Mr X's care and support. Mrs Y said there had then been pressure to identify a suitable placement quickly.
33. The Council advised in late September that additional transition work was needed for Mr X, recommending joint observations by staff from both placements and continued liaison with Mrs Y. After visiting Placement 2, the Council issued a written risk summary for the provider to address. By early October, the Council and Mrs Y confirmed Placement 2 could meet Mr X’s care needs, including day centre attendance and associated transport. Costs were agreed and Mr X completed several accompanied visits, before formally moving into Placement 2 on 7 October 2024.
34. On 13 October 2024, Mrs Y complained the Council moved Mr X into Placement 2 without full agreement and without a proper transition. She said the Council rejected an extended transition, instead proposing one month. She said the Council then reduced this to nine days and then to none. Mrs Y also said she had discovered Mr X lived with a resident who had been involved in a previous violent incident with him. Mrs Y said the move was rushed and unsafe. The Council sought updates from Placement 2 on Mr X’s adjustment and asked to arrange a review.
35. On 25 October 2024, the Council responded to Mrs Y’s complaints:
• The Council said it had not reduced Mr X’s support when he moved to Placement 1, maintaining some day centre attendance and flexible care hours for stability. It attributed Mr X’s deterioration to Placement 1’s inability to meet his needs and manage his behaviour, rather than any reduction in support. The Council said it had a duty to safeguard Mr X and others, and therefore had to move him due to his escalating behaviour.
• Regarding Mr X’s transition to Placement 2, the Council accepted a longer transition would have been preferable, but said it acted properly due to the urgency of the situation. The Council said Mrs Y had visited and approved Placement 2, and the transition was shorter than planned because Mr X then settled quickly. The Council said it could not discuss other residents due to confidentiality reasons, but said both residents’ needs could be met safely and there were no risks to either. The Council said it would monitor the situation and address any issues that arose.
36. Mrs Y escalated her complaint. She said the Council's responsibility was to meet an individual's needs and not apply a standard approach to care. She said Placement 1 failed because the Council did not provide Mr X with the support he needed and this was why his behaviour deteriorated. Mrs Y was concerned the Council would reduce Mr X’s support in Placement 2 over time.
37. In late November 2024, the Council held a review of Mr X’s care at Placement 2. The review found Mr X's placement was going well. It said Placement 2 would develop day activities and the Council would decide on Mr X’s day centre attendance early in the following year.
38. In early December 2024, the Council responded to Mrs Y’s escalated complaint. It said it had given significant thought to meeting Mr X's needs throughout. It's acknowledged Mrs Y’s concerns about the transition process. The Council said it made decisions with urgency and in consultation with the family to protect the wellbeing of Mr X and others. It said the Council had accounted for feedback and input from professionals throughout, and a longer transition to Placement 2 had proved unnecessary. The Council said it would ensure it provided person centred care that met Mr X’s best interests.
39. Mrs Y complained she had not seen Mr X’s needs assessment, despite asking for this several times. Mrs Y was concerned there was no needs assessment, or the Council had not updated it. In January 2025, the Council responded, apologising for the delay in providing the assessment. It provided copies of records and said reviews of Mr X's care had been ongoing. The Council said Mr X’s care and support could change, subject to review.
40. In March 2025, the Council decided Mr X was not eligible for housing benefit at Placement 2. The Council completed a needs assessment and sent a copy to Mrs Y. Mrs Y said she asked for amendments, after seeking professional advice. Mrs Y said the Council sent her an amended assessment in April 2025, but this remained inaccurate.
41. Mrs Y complained the Council had failed to consult Mr X's family when completing the needs assessment and then failed to consider her requested amendments. Mrs Y also complained about the Council's housing benefit decision.
42. The Council responded to both complaints:
• The Council said Mr X’s needs assessment accounted for Mrs Y’s views. The Council said it had reviewed the assessment again for accuracy. It said it reserved the right to consider alternative care package proposals if they better suited Mr X's needs. The Council provided a copy of an updated assessment.
• The Council also explained why it believed Mr X was not eligible for housing benefit. The Council said it considered Mrs Y’s complaint as an appeal and would forward the matter to the tribunal service.
43. In June 2025, Mrs Y asked the Council to escalate her complaint about Mr X’s needs assessment, seeking further amendments. The Council said it would not escalate the complaint, because Mrs Y had approached the Ombudsman.

Analysis

Complaint the Council failed to properly assess and consider relevant information between October 23 and October 24

44. The Council explained it reduced Mr X’s day centre attendance because it expected Placement 1 to provide on-site care, support and activities for Mr X. It said it opted to maintain some day centre services to provide Mr X with continuity following the extended transition into Placement 1. While having reservations about the reduction, Mrs Y said she accepted the Council’s judgement, particularly because she understood the Council would revisit that decision if needed.
45. I have not found the Council acted with fault in making this initial decision. It was entitled to exercise professional judgement to decide how best to provide care that met Mr X’s identified needs. I would consider opting to maintain three days of day centre attendance, when it would not ordinarily do so, demonstrates consideration for Mr X's personal circumstances. While I recognise Mrs Y had reservations, the Council reaching a different professional conclusion would not be fault.
46. The crux of Mrs Y's complaint is, having indicated it would be prepared to revisit its decision, the Council then failed to do so, despite there being sufficient cause. The available records make clear that, following the review held in December 2023, the Council expressed an intent to return to its funding panel to seek added care hours for Mr X. Mrs Y says the Council then did not do so. It instead opted to explore alternative placements while frustrating Mr X’s access to increased support, causing an avoidable deterioration in Mr X's behaviour that made it untenable for him to remain at Placement 1. Mrs Y said by the time the Council did return to its funding panel in August 2024, it was too late.
47. The evidence shows that, following the review meeting, the Council intended to approach its funding panel once Placement 1 made a written request for additional resources. When Placement 1 made its request, it included examples of Mr X’s challenging behaviour. This appears to have given the Council pause, steering it away from approaching the funding panel and instead seeking to understand the root causes of Mr X’s behaviour and whether Placement 1 would continue to be suitable.
48. As set out in the timeline above, the Council repeatedly revisited this issue over the next few months: considering whether Placement 1 was appropriate, taking professional advice, asking Placement 1 to make adjustments and then asking Placement 1 to request additional care hours. Each time Placement 1 made its request, the Council reassessed the situation, rather than progressing to panel, until it ultimately went to panel in August 2024.
49. It was legitimate for the Council to explore Placement 1’s concerns and I accept doing so could take time. However, the evidence does not suggest Mr X’s behaviour changed significantly between the reports the Council received in December, January and February, and when the Council approached the panel in August. While the Council was not wrong to investigate these concerns, I consider it could reasonably have approached the panel sooner as part of this process, particularly given it assured Mrs Y it would do so. The Council’s assurances raised Mrs Y’s expectation of actions that did not follow. I have therefore found the Council at fault for not approaching the panel sooner. I consider this caused Mrs Y avoidable frustration, which is an injustice.
50. However, I cannot say any delay in approaching the panel caused Mr X’s deteriorating behaviour, or that an earlier referral would have led to Mr X’s residency at Placement 1 being a success. Placement 1 consistently expressed concerns about whether it was suitable for Mr X and later suggested that even with increased support, it was not sure it could meet Mr X’s needs. At the later best interests meeting, explored in more detail below, professionals also identified several possible factors that could have contributed to Mr X’s challenging behaviours.

Complaint the Council made Mr X move from one accommodation setting to another at short notice, without regard for his best interests and without proper planning, in October 2024

51. The principles of best interests decision-making say when deciding what is in someone’s best interests, decision-makers should consider all relevant circumstances. They should involve the person as much as possible, and not base their decision simply on age, appearance, condition, or behaviour. Authorities should consider an individual’s wishes, beliefs and values, and consult those closely involved in their care, including family, professionals, and any person appointed to act on their behalf. This is a non-exhaustive set of principles, as law and guidance cannot anticipate every decision and every set of circumstances.
52. The available evidence shows the Council consulted professionals involved in Mr X’s care and support, Mr X’s family, and Placements 1 and 2 in the run up to the best interests meeting. At the meeting:
• The Council heard from social care professionals, psychologists working with Mr X, Mr X’s family, and Placement 1. The written record of the meeting states consideration was given to the principles of the mental capacity act and the code of practice.
• The Council explored what actions Placement 1 had taken to address Mr X’s challenging behaviours. Placement 1 said it had implemented strategies from health professionals and updated Mr X’s risk assessments, but there had been no improvement. Placement 1 said it believed Mr X was unhappy residing there.
• Mr X’s family’s view was that Mr X’s behaviours were not new. Mrs Y said the deterioration in Mr X’s behaviour was brought about by changes in the residents and layout at Placement 1. She also said the Council reducing Mr X’s day centre attendance was a causative factor.
• The psychologist working with Mr X said several factors had impacted Mr X over the previous six months, including changes in his family’s wellbeing, changes in Placement 1, and a reduction in services, though these had recently been reinstated. Ultimately, the psychologist said Placement 1 was not big enough for Mr X and Mr X needed more meaningful activities.
• The Council weighed up these factors and decided Placement 1 was not suitable.
53. I recognise Mrs Y strongly disagrees with the conclusions reached and with some of the representations made in the meeting. Mrs Y has said the Council reached the wrong decision and it was in Mr X’s best interests to remain at Placement 1 with increased support. The evidence shows the Council had regard for the principles of best-interests decision making, consulted with appropriate professionals, and reached conclusions it was entitled to reach while having regard for the views of those involved. I have not identified fault in the way the best interests meeting was conducted. I cannot therefore question the outcome.
54. When arranging the meeting, the Council proposed and agreed a convenient date with Mrs Y. It then moved the meeting forward at short notice, citing the urgency of the situation as the reason for doing so. The evidence available does not show what prompted this urgency, beyond factors the Council was already aware of, and it is unclear what specifically led the Council to move the meeting forward. In the absence of any clear evidenced event or report on which the Council can rely as grounds for advancing the meeting, I have found the Council at fault for proceeding on short notice. In the event, Mrs Y was able to attend the meeting and present her views, but this change caused avoidable distress and frustration, which are injustices.
55. The available records show the Council liaised with both Placement 1 and Placement 2, arranging for staff from each placement to shadow each other in both settings and accompany Mr X on trial days. The Council also visited Placement 2, assessing the potential risks and making recommendations about how Placement 2 should address these. The evidence shows the Council had regard for Mr X’s best interests in the transition and I have not found it at fault for this.
56. In its complaint responses, the Council accepted a longer transition would have been preferable. However, it said it had to act promptly due to the urgency of the circumstances and, in the event, Mr X adapted quickly to living at Placement 2, making a longer transition unnecessary.
57. I have not found the Council at fault for dynamically adapting to Mr X’s presentation and shortening the transition period. Doing so suggests the Council had regard for Mr X’s presenting needs and behaviours. However, I have seen little evidence to show how the Council communicated these judgements to Mrs Y at the time, as representative for Mr X’s family. I note the Council’s assertion the situation was complex and fast-moving, though believe this increased the need for effective communication with Mrs Y. I have found the Council at fault for inconsistent communication with Mrs Y during the transition itself. This caused Mrs Y some avoidable frustration and uncertainty.

Complaint the Council incorrectly decided Mr X was not entitled to housing benefit or financial assistance

58. The Council decided Mr X was not entitled to Housing Benefit in Placement 2. Mrs Y complained about this and the Council upheld its decision. In its response, it said it would register Mrs Y’s concerns as an appeal. When responding to my enquiries, the Council was unable to confirm it had done so.
59. The Ombudsman cannot determine Mr X’s entitlement to housing benefit. In the event of a dispute or disagreement, the correct method of redress would be for the Tribunal to consider the matter.
60. I have found the Council at fault for not passing the matter to the Tribunal, as it said it would. This means Mrs Y still has not received clarity on Mr X’s housing benefit entitlement for the period in question. This uncertainty is an injustice.

Complaint the Council failed to update Mr X’s care and support needs assessment or provide a copy, and refused to consider a complaint

61. Mrs Y said the Council failed to update Mr X’s care and support needs assessment when he moved into Placement 2. The evidence shows in November 2024, the Council conducted a review of the care and support Mr X was receiving, shortly after he moved into Placement 2. As part of this exercise, the Council reviewed relevant records with Placement 2 and made several recommendations. However, the Council appears not to have updated the assessment paperwork then. The Council appears not to have updated Mr X’s care and support needs assessment until March 2025, following Mrs Y’s complaint.
62. I have found the Council at fault for failing to update Mr X’s care and needs assessment paperwork before March 2025. This caused Mrs Y avoidable uncertainty about the content of the assessment and some elements of care Mr X was receiving.
63. The Council reviewing and updating the assessment partially addressed this injustice. However, Mrs Y raised further concerns about co-collaboration and the accuracy of Mr X’s plan, after receiving it. Mrs Y sought to escalate her complaint, after being dissatisfied with the Council’s response. The Council then refused to consider Mrs Y’s complaint at stage two, citing the fact Mrs Y had approached the Ombudsman.
64. I consider the Council acted with fault when it refused to escalate Mrs Y’s complaint. This caused Mrs Y avoidable time and trouble, while leaving specific concerns unaddressed. I have recommended the Council act to address this injustice.

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Action

65. Within four weeks of the final decision being issued, the Council has agreed to:
1. Provide a written apology to Mrs Y and Mr X for the faults and injustice identified in this statement. The Council should have regard to the Ombudsman’s guidance on “Making an effective apology", set out in our published Guidance on Remedies.
2. Consider Mrs Y’s concerns about Mr X’s current care plan and conduct a further review of Mr X’s current needs.
3. Pass Mrs Y’s housing benefit appeal to the Tribunal, if it has not already done so.
66. The Council should provide us with evidence it has complied with the above actions.

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Decision

67. I have completed my investigation with a finding of fault causing injustice. I have made recommendations to remedy the injustice caused.

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Investigator's decision on behalf of the Ombudsman