Summary: Ms X complained about a social care assessment leading to a decision to end her care package. There was poor communication and a failure to act in line with Care Act 2014 eligibility regulations which was fault causing avoidable distress, time and trouble and a loss of care services. There is no fault in reducing the hours of care and support allocated to meet Ms X’s needs. The Council will apologise, make payments to Ms X and issue a reminder to council staff to provide details of the appeal procedure and to signpost us at the end of the complaint procedure.

The complaint

1. Ms X is disabled and receives a council-funded care package. She complained:
1. A social worker conducted an assessment of her needs by phone without informing her;
2. The social worker did not tell her the outcome of her assessment and told the care provider to end her care and support. She found out her care and support was ending when the care provider told her; and
3. She complained about the Council’s decision to end her care and support. It carried out another assessment and reinstated her care, but it provided fewer hours than she had been getting.
2. Ms X said this affected her mental health, caused avoidable distress and a loss of care and support services in January 2025.

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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. 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

5. I considered evidence provided by Ms X and the Council and relevant law, policy and guidance.
6. Ms X 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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What I found

Relevant law and guidance

7. Our Principles of Good Administrative Practice set out our expectations of councils. We expect them to:
• Be citizen focused. This means informing people who use services what they can expect and what the organisation expects of them, keeping to commitments including any published service standards and dealing with people helpfully, promptly and sensitively.
• Putting things right. This means operating an effective complaints procedure, which includes offering a fair and appropriate remedy when a complaint is upheld.
8. A council must carry out an assessment for any adult with an appearance of need for care and support. The assessment must be of the adult’s needs and how they impact on their wellbeing and the outcomes they want to achieve. It must also involve the individual and where appropriate their carer or any other person they might want involved. (Care Act 2014, section 9)
9. The Care Act spells out the duty to meet eligible needs (needs which meet the eligibility criteria). (Care Act 2014, section 18)
10. An adult’s needs meet the eligibility criteria if they arise from or are related to a physical or mental impairment or illness and as a result the adult cannot achieve two or more of the following outcomes and as a result there is or is likely to be a significant impact on well-being:
• Managing and maintaining nutrition
• Maintaining personal hygiene
• Managing toilet needs
• Being appropriately clothed
• Making use of the home safely
• Maintaining a habitable home environment
• Accessing work, training, education
• Making use of facilities or services in the community
• Carrying out caring responsibilities.

(Care and Support (Eligibility Criteria) Regulations 2015, Regulation 2)

11. An adult is to be regarded as being unable to achieve an outcome if they
1. Cannot achieve it without assistance;
2. Can achieve it without assistance but doing so causes the adult significant pain, distress or anxiety;
3. Can achieve it without assistance but takes significantly longer than would normally be expected.

(Care and Support (Eligibility Criteria) Regulations 2015, Regulation 3)

12. If a council decides a person is eligible for care, it should prepare a care and support plan which specifies the needs identified in the assessment, says whether and to what extent the needs meet the eligibility criteria and specifies the needs the council is going to meet and how this will be done. The council should give a copy of the care and support plan to the person. (Care Act 2014, sections 24 and 25)
13. The care and support plan must set out a personal budget. A personal budget is a statement which specifies the cost to the local authority of meeting eligible needs, the amount a person must contribute and the amount the council must contribute. (Care Act 2014, section 26)
14. Statutory Guidance explains a council should review a care and support plan at least every year (Care and Support Statutory Guidance, Paragraph 13.32)
15. The Council has an appeal procedure for addressing disputes about:
• The contents of a social care assessment
• Amount of funding allocated to meet needs (the personal budget)
• Choices about how to achieve the outcomes on a care and support plan.
16. The adult submits an appeal form either on-line, or they can do it over the phone. Advocacy is available where needed. The appeal has the following steps:
1. A social worker may contact the person to try and resolve the issue through discussion. If resolution isn’t possible then
2. A review will be carried out by a manager not previously involved. The review may involve a meeting. The final decision will be made in writing and will either confirm the original decision or accept the appeal, with changes to the assessment or funding.

The next stage is for the adult to complain to the LGSCO.

Background

17. Ms X is disabled and has been receives a package of home care arranged and funded by the Council. An assessment several years ago said she was eligible under six of the domains set out in paragraph 10 and the Council arranged and funded her care using a care agency. Ms X was receiving a daily support of 30 minutes, a weekly shopping call of one hour and a monthly session of two hours to support her to attend any appointments.
18. The most recent review of the care and support plan (before the actions which led to Ms X’s complaint to us) was in February 2022. This said Ms X was receiving a care package to meet the following needs:
• Managing and maintaining nutrition – support to do a weekly food shop (45 minutes a week; additional 15 minutes to collect prescription)
• Maintaining the home – support with cleaning (30 minutes a day).

Summary of key events

19. Ms X told me she contacted the Council about problems she was having with her care agency, which are not part of her complaint to us. A social worker later completed a social care assessment after speaking to her on the phone. Ms X said the social worker did not tell her she was completing an assessment and Ms X thought it was about getting one-off support to attend a hospital appointment.
20. The social worker noted in mid-October that they were completing a ‘review’ and this was in respect of a request from Ms X for additional funding for support to attend a one-off hospital visit. An internal note by the social worker said a Care Act reassessment was required.
21. The outcome of the assessment was the only eligibility outcome (see paragraph 10) Ms X met was maintaining a habitable home. The assessor noted in summary that

“Ms X is physically able to complete all of the eligibility criteria independently, only requiring support with maintaining a habitable home environment. Ms X was previously assessed as requiring PA support 2 hours a month to enable her to access the community for hair appointments, dental appointment and shopping. She shared that she would plan/ decide every month what the hours were used for.

Ms X shared that she is physically able to manage all her care and support needs without support in place. The care agency have stated that she has been observed standing or walking between her lounge and kitchen during the duration of the 30 min care call. After liaising with the agency, it was identified that Ms X would benefit more from a cleaning service instead of receiving a formal package. Currently the agency are only providing support around maintaining a habitable home “

22. Ms X objected to the outcome of the reassessment so the Council used the appeal procedure. A duty social worker carried out a second social care assessment in December 2024. The outcome unchanged. The assessor noted in summary that

“Ms X has been reassessment [sic] to be deemed not eligible for care and support under The Care Act (2014).

Ms X is able to manage all aspects of the eligibility criteria independently, with minimal support to complete certain household tasks such as hanging her clothes washing and washing up.

Although Ms X can become tired easily and certain aspects of daily living may take a prolonged amount of time, she is able to do independently prepare a meal, dress herself, maintain relationships, access the community and manage her health needs. Ms X currently has a mobility scooter to support accessing the community as well as a stool in the bathroom and kitchen to support with personal care and nutrition.

23. The Council provided the LGSCO with a letter dated 29 November, which does not have Ms X’s address on it. Ms X said she did not receive this letter until the middle of December. The letter said the Council was stopping her care from 3 January 2025 because she was no longer eligible. It enclosed a copy of her assessment and gave contact details for the customer care team if she wished to discuss the letter. Ms X told me the care agency had told her that her care would be stopping in January, before she received the Council’s letter.
24. Ms X’s GP wrote to the Council on 20 December 2024 saying she was in desperate need of keeping her care package.
25. On 31 December, a team manager wrote to Ms X about the appeal process and said she would send the appeals leaflet under separate cover.
26. An advocate representing Ms X submitted a detailed appeal at the start of January 2025. The main points were:
• The assessment did not reflect detailed points that she had made about how her condition affected her everyday life and glossed over or left out relevant information.
• The assessor did not understand that Ms X’s ‘low energy’ was not something she could just push through and was related to biological processes in Ms X’s body.
• There was a failure to apply statutory guidance and the national eligibility criteria properly. The criteria said a person is to be regarded as unable to achieve an eligibility outcome if doing so causes the adult significant pain distress or anxiety or took them significantly longer than would be expected due to a disability. It wasn’t a matter of Ms X “being tired” when shopping, cooking, showering, maintaining relationships: doing those activities without care and support exacerbated her condition, left her exhausted and extremely unwell.
• Maintaining a habitable home was not considered in the assessment.
27. A manager completed a further social care assessment dated 11 February 2025. The outcome was:
28. Ms X was eligible for care and support in the following domains/outcomes:
• Maintaining the home (able to achieve the outcome but doing so caused significant pain, distress and anxiety)
• Making use of the home safely (able to achieve the outcome but doing so caused significant pain, distress and anxiety)
• Accessing the community (unable to achieve the outcome.)
29. The manager and Ms X spoke after the assessment and the manager also emailed Ms X confirming the new care package. The manager told Ms X her needs could be met with a care package of 30 minutes three times a week (for housework), an hour for shopping and one and a half hours community support. Ms X said she used to have two and a half hours for community support. The manager said they would not agree to this much time.
30. The records note the care package was commissioned from 27 January 2025 (this means there was a gap in care and support from 3 to 27 January 2025)
31. The Council issued a new care and support plan at the end of February 2025 which set out Ms X’s outcomes and needs. This said her eligible her needs could be met with a care package of 30 minutes three times a week to help maintain the home and 1 hour week for food shopping. And one and a half hour a month with support to make necessary use of community services (noting Ms X could also use taxis)
32. Ms X complained to the Council raising the same issues as in her complaint to us. Ms X said in her complaint to the Council that:
• She found out through the agency that its service was ending.
• She asked to go through the reassessment with the social worker and was informed she met only one out of 10 criteria.
• No-one from the Council told her there was an appeal process. An independent advice agency told her.
• The reassessment was inadequate. It did not say what would happen if she did not have support with shopping and it did not take account of the pain, distress or length of time some tasks took.
• Although the second reassessment concluded she was eligible, there had still been a reduction in the number of hours (now she has 3 evenings and a weekly shopping call, previously it was every evening.
33. The Council said in response to her complaint (in its email is dated 7 March 2025) that it had already addressed her complaint through the appeal process and ger assessment and care and support plan had been updated.
34. Another advocate acting for Ms X contacted the Council at the start of April to complain on Ms X’s behalf. The Council responded saying all areas were covered in the second assessment and funding had been put in place where there was a need which Ms X either could not manage, or could not manage without significant pain, distress or anxiety. The Council’s letter signposted her to a different officer, but not to the LGSCO.
35. Ms X complained to us.

Was there fault?

A social worker conducted an assessment of Ms X’s needs by phone without informing her

36. The case records indicate the social worker informed Ms X that she was completing a review (of her care and support plan) rather than an assessment.
37. This was poor communication and was fault causing avoidable confusion and distress.

The social worker did not tell Ms X the outcome of her assessment and told the care provider to end her care and support. She found out her care and support was ending when the care provider told her

38. The Council’s letter of 29 November 2024 informed Ms X that her care would be ending. The letter was delayed – Ms X did not receive until the middle of December. The delay had two possible causes: the postal service or the Council not posting it straight away. There is not enough evidence of fault by the Council.

Ms X complained about the Council’s decision and it carried out a further assessment and reinstated her care, but it provided fewer hours.

39. There is nothing in the Care Act or in Care and Support Statutory Guidance which prevents a council from carrying out a further social care assessment for a person who is eligible for and is receiving council-funded care and support. There may be various reasons for completing a fresh assessment: a person’s condition may have improved or declined, they may be receiving support from a third party to meet needs which the authority was meeting and no longer needed to meet. There is no fault in carrying out an assessment.
40. There was fault in the assessments of November and December 2024 which did not consider the pain, distress and anxiety Ms X suffered when carrying out tasks associated with eligibility domains. The assessments were not in line with the regulations I have set out in paragraph 11. This meant the eligibility decisions in those assessments were flawed.
41. It is not for the LGSCO to say how many hours of care and support are required to meet a person’s eligible unmet needs. There has been a reduction in Ms X’s care and support with which she disagrees. Looking at the 2022 review of the care and support plan, Ms X’s weekly support has been around housework tasks and shopping with a higher allocation of time until 2025. There are no grounds for me to conclude an hour and a half a week for housework and an hour for food shopping is fault.
42. The social worker’s letter at the end of November 2024 telling Ms X her care was stopping should have informed her of the right to appeal against the decision and given her information about how to appeal. The failure to give information about the appeal procedure was poor communication, not in line with our expected standards and was fault. And the final appeal response and complaint response should also have signposted Ms X to the LGSCO.

Did the fault cause injustice?

43. The failure to inform Ms X of her right of appeal caused avoidable distress, time and trouble and confusion and meant she had to seek out independent advice about her options. The failure to complete assessments in line with national eligibility regulations meant the Council’s decision to stop Ms X’s care was flawed. Instead, she should have had a decision to continue her care albeit with a reduced number of hours. This means she had a loss of around 12 hours of care for January 2025.

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Agreed Action

44. The Council will, within one month, issue:
• An apology to Ms. X We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisation should consider this guidance in making the apology I have recommended in my findings.
• A payment of £250 to Ms X to reflect the loss of a month of care and support
• A payment of £150 to Ms X reflect her avoidable distress.
• A reminder to staff in adult social care to signpost adults to the appeal procedure when issuing a decision to stop or reduce a person’s care and support.
• A reminder to those staff responding to complaints about adult social care that they need to signpost the LGSCO when issuing final complaint responses.
45. 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 agreed actions to remedy the injustice.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman