Summary: The Council was not at fault in relation to the care and support it provided to Mr X, and for later withdrawing that care.

The complaint

1. Mr X complained the Council did not provide him with his agreed support package in early 2024 and withdrew the support following a review in late 2024. He also complained that, after a stay in hospital in March 2024, the Council delayed in arranging care at home and the care provided was of poor quality. He says that the withdrawal of care has resulted in his physical and mental health deteriorating. He wants the care to be reinstated.

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The Ombudsman’s role and powers

2. 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)
3. We must also consider whether any fault has had an adverse impact on the person making the complaint, which we call ‘injustice’. We provide a free service, but must use public money carefully. We do not start or continue an investigation if we decide any fault has not caused injustice to the person who complained (Local Government Act 1974, section 24A(6), as amended, section 34(B))
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. 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 Mr X and the Council as well as relevant law, policy and guidance.
7. Mr 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 have and have not investigated

8. Mr X complained the care provided by the Council after his discharge from hospital was of poor quality. He said the carers provided him with food that was out of date or undercooked. As set out at paragraph 3, we do not start or continue an investigation if we decide any fault has not caused injustice to the person who complained. I have seen no evidence that Mr X suffered any injustice because of eating undercooked or out of date food. And so, I have not investigated this aspect of his complaint.
9. I have investigated the rest of Mr X’s complaints.

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What I found

Law, policy and guidance

Assessment

10. 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.
11. 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.

Care Plan

12. 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

13. 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.

Reablement

14. Reablement support services are for people usually after they have left hospital or when they are at risk of having to go into hospital. They are time-limited and aim to help a person to preserve or regain the ability to live independently. They are provided in the person’s own home by a team of mainly care and support professionals.
15. Regulations require reablement to be provided without charge for up to six weeks. This is for all adults, whether or not they have eligible needs for ongoing care and support. Councils may charge where services are provided beyond the first six weeks but should consider continuing providing them without charge because of the preventive benefits. (Reg 4, Care and Support (Preventing Needs for Care and Support) Regulations 2014)

What happened

16. The Council carried out a Care Act assessment with Mr X in 2022. The assessment found that he had eligible care and support needs in relation to substance use, mental health, and housing, including maintaining his home environment. He refused support at that time.
17. In January 2023, Mr X was referred to a multidisciplinary team service between the Council and other providers (the Service). The Service provided intensive support to people experiencing multiple kinds of disadvantage. It was led by the Council’s Adult Social Care Service, but it also provided support to people who did not have eligible needs under the Care Act.
18. The Service built a relationship with Mr X throughout 2023. It carried out a further Care Act Assessment in September 2023 that identified Mr X had eligible needs for domestic support. With the help of the Service, Mr X agreed to accept domestic support organised by the Council’s Adult Social Care Service. That support (a deep clean followed by a fortnightly clean) started in September 2023.
19. By early 2024 Mr X had contact with support services on most weekdays. On several occasions, Mr X would not allow professionals access to his property. There were also instances where staff said he appeared to be under the influence of alcohol and/or drugs, which meant the staff involved did not consider it safe to provide support to Mr X.
20. Domestic support, in the form of fortnightly cleaning, continued until Mr X was admitted to hospital with an injury in March 2024.
21. In April Mr X discharged himself from hospital. The hospital arranged a reablement package for him that included several visits per day for personal care, meals, medication, and support with toileting.
22. In June the Council reviewed Mr X’s care and support plan. This review included reports from Physiotherapy, Occupational Therapy, and his NHS-commissioned carers, all stating that Mr X’s mobility had improved since his discharge from hospital. The review found that Mr X needed one short care visit per day (with two members of staff present) to meet his daily care needs, plus one hour of cleaning per week and another hour of shopping.
23. The Council contracted a care agency to provide care from 10 June onwards. This arrangement was increased to 16 hours per week in July, and continued until September. At that point the care agency gave notice with immediate effect because Mr X had made racially abusive comments and threats of physical violence towards their staff.
24. Mr X told the Service that he no longer needed personal care and wanted to try to be independent. He still required domestic support and the Service arranged for this to be increased immediately after the care agency had given notice in mid-September. The cleaning company then gave notice in October due to Mr X’s “increased verbal abuse, inappropriate sexual comments made to carers, and threats towards staff”.
25. The Council found it difficult to find a new provider due to concerns about staff safety. Mr X was without support from 21 October to 20 November 2024, when a new care provider started providing domestic support. The Council also funded another deep clean before that.
26. The Council started a further review of Mr X’s care and support plan in October 2024. The assessment included reports from Physiotherapy, Occupational Therapy, and the care provider, all of which stated that Mr X no longer required support with personal care, toileting, meals and medication, as his mobility had improved. He had been observed to be independently mobile. Physiotherapy recommended some mobility aids and equipment that would further help Mr X’s independence, and the Council sourced these.
27. As well as the improvement in his physical condition, the assessment said that Mr X had engaged with therapy assessments and that had helped him to become more independent.
28. The assessment concluded that Mr X’s improved mobility and his renewed ability to manage aspects of his daily life by himself meant he no longer had eligible care needs. Although he still had issues with substance use and mental health, these did not meet the eligibility threshold under the Care Act.
29. The Council recognised Mr X still needed ongoing support with domestic tasks, but, as he no longer had eligible care needs, the Council said it no longer had a duty to meet those needs. Instead, it was willing to help Mr X to arrange his own domestic support. The completed assessment was discussed with Mr X in late November.
30. Mr X chose to cancel the care contract at the end of December 2024. In February 2025, the Service informed Mr X that it would no longer support him. Mr X escalated his complaint to the Ombudsman in March.

Analysis

Support provided in early 2024

31. Mr X complained the Council did not provide him with his agreed support package in early 2024, before he went into hospital. Mr X’s care and support plan included domestic support. The Council has provided me with evidence that this was provided by a mental health-experienced cleaning agency.
32. The Service also provided Mr X with support outside of his support plan. In February alone, the Service had more than 20 interactions (in person, by telephone, email, or text message) either with or about Mr X. These interactions included:
• arranging appointments with Mr X’s dentist and GP and supporting him in attending these,
• arranging for him attend a (non-GP) medical appointment and a peer support group, and
• visiting him at home (weekly) to provide in-person support.
33. The Service, and by extension the Council, was not at fault.

Care on return from hospital in Spring/Summer 2024

34. Mr X complained that, when he discharged himself from hospital, it took the Council’s adult social care team “months” to arrange domiciliary care.
35. The Council has provided me with evidence that the hospital arranged a reablement package for Mr X when he returned home from hospital. It included several care visits each day. As set out at paragraph 14 and 15, it is standard practice for the NHS and/or the Council to provide this service for up to six weeks, after which the Council carries out a Care Act Assessment (or a review, in the case of someone who has previously had a full assessment, like Mr X). This is done to determine whether someone has ongoing eligible care needs following a period of acute ill-health.
36. This is the process that the Council carried out in Mr X’s case, with a Council-contracted care agency taking over daily care visits from 10 June. There was no gap in care between the initial reablement package ending and the medium-term care package starting. I find no fault with the way the Council administered the Care Act assessment and planning process and the care that it arranged for Mr X following his return from hospital.

Withdrawal of care in late 2024

37. Mr X complained that the Council withdrew care in late 2024. The Council’s commissioned providers delivered Mr X’s care from June 2024 to October 2024. The care agency stopped providing care to Mr X in September as it was unhappy with his behaviour towards staff. The cleaning company stopped providing support to Mr X in October, for the same reason.
38. Mr X was then without Care Act-mandated support from 21 October to 20 November 2024. It took the Council a month to source a provider that was willing and able to support Mr X. I have seen evidence that the Council made attempts to arrange support during that time. I am satisfied the Council did all it could to arrange new support for Mr X when his existing support unexpectedly ended. The Council was not at fault.
39. The Council completed a review of Mr X’s care and support plan, with his involvement, in October/November 2024. This review was started because, as Mr X told the Service in September 2024, he no longer needed personal care and wanted to try to be independent. The conclusion of the review was that, because of both his improved physical health and his improved ability to function independently, Mr X no longer had eligible care needs.
40. Our role is not to ask whether an organisation could have done things better, or whether we agree or disagree with what it did. Instead, we look at whether there was fault in how it made its decisions. If we decide there was no fault in how it did so, we cannot ask whether it should have made a particular decision or say it should have reached a different outcome.
41. I have considered the steps the Council took to assess Mr X’s needs in October/November 2024, and the information it took account of when deciding Mr X no longer had eligible care needs. There is no fault in how it took the decision and I therefore cannot question whether that decision was right or wrong.

End of the Service in February 2025

42. The other support provided to Mr X by the Service was provided outside of the Care Act Assessment process, and adults do not need to have eligible care needs to be eligible for its services. This service is provided at the Council’s sole discretion, and I find the Council was not at fault in deciding to stop providing this service to Mr X.

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Decision

43. I have completed my investigation with a finding of no fault.

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Investigator's decision on behalf of the Ombudsman