Summary: Mrs X complained about the Council’s decision not to provide her with a home care package. She said the Council relied on incorrect information in making this decision. The Council was not at fault. It carried out Mrs X’s social care and needs assessment in line with relevant law and policy.

The complaint

1. Mrs X complained about the Council’s decision not to provide her with a home care package. She said the Council relied on inaccurate information from an Occupational Therapist assessment and misinterpreted her medical records.
2. She said this has caused her distress and has left her without the support she needs which is negatively affecting her health.

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The Ombudsman’s role and powers

3. 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)
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(1), as amended)

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How I considered this complaint

5. I considered evidence provided by Mrs X and the Council as well as relevant law, policy and guidance.
6. Mrs 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. 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.
8. 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. When a council decides a person is not eligible for support it must provide that person with a copy of its decision.

Eligibility Criteria

9. An adult’s needs are only eligible where they meet all three of these conditions:
• the adult’s needs arise from or are related to physical or mental impairment or illness;
• as a result of the adult’s needs the adult is unable to achieve two or more specified outcomes;
• as a consequence, there is, or is likely to be, a significant impact on the adult’s well-being.
10. Specified outcomes:
• managing and maintaining nutrition.
• managing personal hygiene.
• managing toileting needs.
• being appropriately clothed.
• being able to make use of the adult’s home safely.
• maintaining a habitable environment. 
• developing or maintaining family or other personal relationships.
• accessing and engaging in work, training, education or volunteering.
• making use of necessary facilities or services in the local community including public transport and recreational facilities.
• carrying out caring responsibilities for an adult or child.

What happened

11. Mrs X was born with a complex heart condition, which causes fatigue and breathlessness. Over the years, Mrs X has had several care support plans.
12. In April 2024, she began receiving four hours per week of carer’s relief for supporting her husband. This support remains in place.
13. Following this, Mrs X applied to the Council for an assessment of her own care and support needs, hoping to reinstate a previous care plan which ended in August 2017.
14. The Council contacted Mrs X to arrange assessments with an Occupational Therapist (OT). Mrs X initially declined to engage until she received confirmation the OT understood her complex health conditions.
15. The Council contacted Mrs X’s cardiologist, who explained her symptoms and medical background in a telephone call. The cardiologist (who referred directly to her medical records) explained her heart function was good and, following her bypass procedure, there were no valve abnormalities. The cardiologist noted that the only likely symptoms should be reduced exercise tolerance and fatigue.
16. The Council shared a summary of this conversation with Mrs X as confirmation that it had consulted with her doctor and familiarised itself with her condition. Mrs X agreed to proceed with the OT assessment. Mrs X neither commented on nor challenged the accuracy of the information.
17. The Council arranged several OT assessments between July 2024 and January 2025, during which Mrs X was observed carrying out domestic tasks such as folding laundry and shopping at a local supermarket.
18. In its needs assessment, the Council recorded Mrs X’s health conditions and acknowledged that she had care and support needs. However, it concluded that she did not meet the eligibility criteria for a care package.
19. In February 2025, the Council informed Mrs X that it would not provide her with a home care plan.
20. Mrs X challenged this decision, disputing the outcome of the assessment by complaining to the Council. She said the Council’s assessment failed to consider the full scope of her health conditions.
21. The Council responded and said it had completed thorough assessments over six months, including home visits including one focused on a laundry task, during which it observed Mrs X carrying laundry upstairs and folding it. The Council liaised with her medical specialists, and observed her in daily activities. It suggested pacing and fatigue management techniques, and advised that her carer’s relief hours could be used to support her own needs as well as her caring role for her husband.
22. Mrs X remained unhappy with this response and complained to us.
23. She said the OT notes from the laundry visit were inaccurate and the Council had misinterpreted her medical condition. She explained she is unable to carry laundry upstairs but instead drags bags of laundry up the stairs.
24. Following our enquiries, the Council clarified that the notes from the laundry visit did not state that Mrs X carried laundry upstairs. Instead, the records show she was observed folding items from a drying rack located downstairs in the living room. The Council acknowledged it had misinterpreted these notes when responding to Mrs X’s complaint. However, it maintained that the OT assessment accurately reflected the observations made on the day.

My findings

25. It is not the role of the Ombudsman to decide whether a person should receive a care and support package. The Ombudsman’s role is to establish whether the Council assessed the person’s needs and considered relevant evidence in line with the law and relevant policy.
26. When the Council completed Mrs X’s care and needs assessment, it included detailed records of Mrs X’s medical conditions, it listed her needs, the ways these affect her wellbeing, and the outcomes she wished to achieve. It also included notes of discussions with her medical professionals. The Council also carried out other visits to observe Mrs X and considered this in making its decision. The Council decided Mrs X does not need a care package and instead proposed various strategies and techniques to help Mrs X manage domestic tasks. There was no fault in the way the Council assessed Mrs X’s care needs and therefore I cannot question the decision not to provide Mrs X with a care home package.

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Decision

27. I completed this investigation as I found no fault.

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Investigator's decision on behalf of the Ombudsman