Summary: Miss Y complained about how the Council delayed providing her mother, Mrs X, with a care package, respite care fees and with aids and adaptations to meet her needs. There were some faults by the Council which caused injustice to Mrs X and Miss Y. The Council will take action to remedy the injustice caused.

The complaint

1. Miss Y complained on behalf of Mrs X that the Council delayed:
1. arranging and providing Mrs X with a care package
2. helping Mrs X with respite care fees
3. providing Mrs X with aids and adaptations required to meet her needs.
2. Miss Y said as a result Mrs X was left without appropriate care and support. Miss Y also said the matter caused her distress and financial difficulties as she had to privately fund Mrs X’s care and respite fees.

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The Ombudsman’s role and powers

3. We investigate complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. 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 an injustice, 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. 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)
6. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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What I have and have not investigated

7. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. (Local Government Act 1974, sections 26B and 34D, as amended)
8. Miss Y made a complaint to the Ombudsman in April 2025, so this investigation should start from April 2024 (12 months before she made her complaint). But I have exercised discretion to investigate matters from when Miss Y asked the Council to provide a care package for Mrs X to when the Council issued its final response to Miss Y’s complaint.
9. To make a meaningful investigation, I have therefore investigated matters from January 2024 to May 2025.

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How I considered this complaint

10. I considered evidence provided by Miss Y and the Council as well as relevant law, policy and guidance.
11. Miss 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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What I found

Law and guidance

12. The Care Act 2014 states councils must assess any adult that appears to have needs for care and support. An adult’s needs arise from or are related to physical or mental impairment or illness; the adult cannot achieve two or more specified outcomes because of those needs, and there is likely to be a significant impact on the adult’s wellbeing.
13. Councils must carry out assessments over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Once a council has determined a person is eligible, it must set out the person’s needs and how the council will meet those needs in a Care and Support Plan.
14. Non-residential care - is care other than in a care home, usually in peoples’ own homes. Non-residential care services include domestic help and personal care at home, day care, and other support from the council such as transport, equipment, and housing adaptations not provided through Disabled Facilities Grants.
15. Respite care - provides temporary, short-term relief for carers, allowing them to take a break from their responsibilities while ensuring the person they care for continues to receive support. It can range from a few hours of home sitting to a temporary stay in a care home. The person’s stay should be unlikely to exceed 52 weeks. A decision to treat a person as a temporary resident must be agreed with the person and/or their representative and written into their care plan.
16. A council can choose whether to charge a person where it is arranging to meet their needs. In the case of a short-term resident in a care home, the council has discretion to assess and charge as if the person were having their needs met other than by providing accommodation in a care home. Once a council has decided to charge a person, and it has been agreed they are a temporary resident, it must complete the financial assessment in line with the Care and Support (Charging and Assessment of Resources) Regulations 2014 and the Care and Support Statutory Guidance.
17. Financial Assessment - Councils must carry out a financial assessment to make a decision about care charges. This will assess the person’s capital and income. The upper capital limit is currently set at £23,250 and the lower at £14,250. A person with assets above the upper capital limit are required to pay for their own care. Even if the capital is below the threshold of £23,250, people may have to pay a contribution from their income towards their care.
18. Direct Payments – are monetary payments made to individuals who ask for them to meet some or all of their eligible care and support needs. They enable people to arrange their own care and support to meet those needs. The council must ensure people have relevant and timely information about direct payments so they can decide whether to request them. If they do so, the council should support them to use and manage the payment properly.
19. Continuing Health Care – is a UK National Health Service (NHS) funded package of care for adults with long-term, complex health needs, such as chronic illness, disability, or end-of-life care. If eligible, the NHS funds the full package of care, which may include home care, nursing care, or care home fees.
20. Mental Capacity - A person aged 16 or over must be presumed to have capacity to make a decision unless it is established, they lack capacity. Where someone’s capacity is in doubt, councils must assess the person’s ability to make a decision. Councils must follow the law set out in the Mental Capacity Act 2005 to decide if individuals can make choices about their care and may need to carry out an assessment of capacity if there is doubt. Capacity is decision specific, can vary over time and an assessment may become outdated.
21. Carer’s Assessment - Where somebody provides or intends to provide care for another adult and it appears the carer may have any needs for support, the council must carry out a carer’s assessment. A carer’s assessment must seek to find out not only the carer’s needs for support, but also the sustainability of the caring role itself. This includes the practical and emotional support the carer provides to the adult.
22. As part of the carer’s assessment, the council must consider the carer’s potential future needs for support. It must also consider whether the carer is, and will continue to be, able and willing to care for the adult needing care. (Care and Support Statutory Guidance 2014)
23. Carer’s Budget and Respite - The Care Act 2014 says the council may meet the carer’s needs by providing a service directly to the adult needing care. The carer must still receive a support plan which covers their needs, and how the council will meet them. The carer’s personal budget must be an amount that enables the carer to meet their needs to continue to fulfil their caring role. It must also consider what the carer wishes to achieve in their day-to-day life. Part of the planning process should be to agree how the carer will use the personal budget to meet their needs. (Care and Support Statutory Guidance 2014)

Key events

2024

24. Mrs X has dementia and Miss Y is her representative.
25. In January, Mrs X moved to Miss Y’s home and on 19 January, Miss Y asked the Council to complete an assessment of Mrs X’s care needs.
26. After a couple of attempts to arrange an assessment for Mrs X, the Council completed a care act assessment for her on 29 February. Miss Y told the Council she provided 24/7 care to Mrs X, but that she occasionally employed a private agency throughout the year to provide respite care and support to Mrs X when she was away every 4 weeks for work. Miss Y asked for home care package for Mrs X in form of a direct payment (DP) for periods she was away for work and not available to care for Mrs X.
27. The Council found Mrs X was eligible to receive care and support to meet her identified needs. The Council agreed a non-residential care package via a DP to employ private carers for Mrs X. The Council discussed financial assessment (FA) with Miss Y, and she agreed that an FA be completed for Mrs X. The Council made an occupational therapy (OT) referral for advice/support with any equipment that could help Mrs X.
28. In April, the Council completed a non-residential FA for Mrs X, and she was assessed to make a £55.35 per week contribution towards her care from 12 April.
29. Miss Y informed the Council she planned to arrange occasional residential respites for Mrs X. The Council told Miss Y that she would likely be charged in full for Mrs X’s respite care if it had not been agreed by the Council. It explained that this was because residential respite care would need to be the Council’s commissioned service and that it would not normally be paid through DPs. The Council said it would need to complete another FA for residential respite for Mrs X to reflect Miss Y’s request.
30. Miss Y said she felt the DP was to pay private carers for respite periods when she was away. Miss Y said Mrs X’s private care had cost her £4,000 so far and the respite care was costing her £900. She asked the Council for an update with Mrs X’s DP.
31. The Council explained the agreed DP was to be used by Miss Y to employ/pay existing or new private carers for Mrs X. The Council told Miss Y that she could apply for carers allowance and that if she was struggling, she could have a carers assessment completed for her. The Council said it had referred Mrs X’s case to the residential panel to consider a 4-week rolling respite per year.
32. In May, the Council decided to complete a mental capacity act (MCA) assessment for Mrs X in relation to managing her finances and consenting to respite care. The panel deferred Mrs X’s case pending the MCA assessment outcomes. Miss Y was notified.
33. Between 7 May and 15 May, Mrs X went into a care home for respite care. The Council reiterated that as it had not yet agreed the respite care, Miss Y would have to pay in full for Mrs X’s respite. Miss Y agreed.
34. At the end of May, the Council completed mental capacity act (MCA) assessments for Mrs X. The Council found Mrs X lacked capacity to manage her finances and to consent to the rolling respite care.
35. In May and June, the Council asked Miss Y to confirm the number of non-residential care hours to support Mrs X’s care needs. Miss Y provided the Council with the information.
36. In June, the residential care panel approved a 6-week rolling respite per year via a DP for Mrs X from 11 June 2024. A total of £4,656 per year (at the rate of £776 per week). The Council told Miss Y she would be given a DP card with one lump sum for her to use flexibly to cover the annual service as and when needed either with home carer staying in her home 24/7 for the day/times needed or to be used in a respite bed. The Council also explained respite care through DPs are charged across the year, so Mrs X would have to make her weekly £55.35 contribution every week of the year and not just when she used the respite. Miss Y agreed to the respite care DP arrangement.
37. The Council backdated the DP for the 6-week rolling respite to 27 May 2024 to end on 25 May 2025.
38. Miss Y said Mrs X’s care package started in mid-June and then she got the DP card and payment in mid-July.
39. Mrs X used her respite package at a residential home between July and November.
40. In mid-November, the Council made an OT referral, and an OT assessment was completed in mid-December. OT made the following recommendations:

• a bath lift with covers
• two raised toilet seats and frames for upstairs and downstairs
• an additional banister rail
• a falls pendant
• bed sensor
• key safe.

41. The same day, the Council made a referral to get the recommended aids and adaptations completed.

2025

42. In January, Miss Y informed the Council that Mrs X had been diagnosed with cancer.
43. Due to Mrs X’s recent diagnosis, Miss Y asked that the OT referral for falls pendant and bed sensor be cancelled. OT provided Mrs X with the bath lift, but during a home visit in mid-January, it was found to be unsuitable to meet Mrs X’s needs and Mrs X did not also want the recommended raised toilet seats. The OT then recommended grab rails to be fixed for Mrs X’s accessibility to the bath and toilets, and it ordered another bath rail.
44. The Council reviewed and updated Mrs X’s care and support plan with the OT and recent FA outcome. It stated the rolling 6-week respite DP was still in place and no additional support was required for Mrs X.
45. In February, all the aids and adaptations except for the cancelled falls pendant and bed sensor were fixed and in April, the OT closed Mrs X’s case.
46. Miss Y told the Council that Mrs X would need a different care package because of her declined health. The Council made enquiries and found Mrs X was not on Continuing Health Care (CHC) list and she was not on any palliative medication.
47. In April, Mrs X’s client contribution was assessed as £67.67 per week. The Council’s records showed Mrs X’s case was stable, the rolling DP respite package remained appropriate and in place and Mrs X was scheduled to be reassessed in January 2026.

Miss Y’s Complaints

48. In April, Miss Y made a complaint to the Council about its delays and failure to support Mrs X with an appropriate care package. Miss Y said despite the respite package put in place for Mrs X, she still incurred £6,000 in care cost for private carers.
49. The Council said:

• there was no delay with arranging and completing Mrs X’s assessment in February 2024 and her FA in April 2024. But it said there was a delay of nine working days in making a referral for the agreed DP.
• although the DP was agreed in June 2024, it backdated it to 27 May 2024. It said therefore, Mrs X’s care package started in May 2024.
• it had offered Miss Y a commissioned service whilst awaiting the agreed DP but that she declined the offer, because she was working from home so was available to provide care to Mrs X at home. The Council said it was therefore not able to award any funding for Mrs X’ care from February 2024 when it first completed her assessment.
• there was a slight delay from the date of the OT referral to the assessment date (mid-November to mid-December 2024) due to an increased OT workload. The Council said it then acted promptly to provide Mrs X with the recommended aid and adaptations after the assessment.
• after Miss Y informed it about Mrs X’s cancer diagnosis, the Council confirmed she was not on any palliative medication, and she did not meet the CHC checklist for NHS funding.
• it could arrange a reassessment and consider putting non-residential care / carer support in place at appropriate times of the day to meet Mrs X’s care needs.

50. Miss Y was dissatisfied with the Council’s response, and she made a complaint to the Ombudsman.
51. Subsequently, the Council informed the Ombudsman, it had reassessed Mrs X’s care needs and Miss Y was happy with the agreed actions to support the identified needs.

Analysis

52. There are no statutory timescales for councils to complete care act assessments. It took the Council approximately six weeks to complete Mrs X’s assessment after Miss Y’s initial contact with the Council (19 January 2024 – 29 February 2024). In the circumstances, this was not an excessive amount of time, so it was not fault.
53. Councils complete care act assessments to identify and put in place the support required by an adult and/or a carer to manage daily living, health conditions or care responsibilities.
54. In this case, I find on balance the Council failed to properly consider Mrs X’s needs during the February 2024 assessment. This is because Miss Y asked for home care package for Mrs X in form of a DP for periods she was away for work and not available to care for Mrs X. But there was no evidence to show how the Council considered Miss Y’s request and how it reached its decision to provide non-residential care package via a DP to employ private carers for Mrs X (not the respite care she requested). This was fault and it resulted in Miss Y chasing the Council for the agreed DPs to provide respite care for Mrs X. This caused Miss Y confusion and uncertainty as to whether the Council properly assessed and agreed to provide Mrs X appropriate care support.
55. Similarly, the Council did not complete a carer’s assessment for Miss Y or agree a support plan for her with how her own needs as Mrs X’s carer would be met by the Council. This was fault. It caused Miss Y uncertainty in not knowing whether the Council properly considered her needs as a carer providing 24/7 care and support to Mrs X.
56. The Council’s initial agreed non-residential care package via a DP to employ private carers for Mrs X and Miss Y’s request for a respite care package for Mrs X were not finalised and put in place until mid-June 2024 and mid-July 2024. These were delays of approximately 4 months and 5 months respectively. These were faults. I find the Council’s delays caused no injustice to Mrs X. This is because Miss Y continued to provide Mrs X with care support. But I find the delays caused Miss Y distress, worry and the financial difficulties of arranging Mrs X’s care via private care and residential respite care.
57. Although the Council finalised the respite care DPs in mid-July 2024, but it backdated the DP to 27 May 2024. I also find on balance that the Council offered Miss Y a commissioned service whilst awaiting the agreed DP which she declined. I find these mitigated the injustice caused to Miss Y.
58. I note the Council said there was a slight delay with the OT assessment completed in December 2024. However, the Council made an OT referral during the February 2024 assessment for Mrs X, but it did not chase its initial referral up with the OT. This was fault. This meant Mrs X was left without appropriate aid and adaptations to meet her care needs over a significant period. This was a 12-month delay, from when Mrs X was first assessed in February 2024 to when all the adaptations were provided in February 2025. The Council’s fault also caused Miss Y distress and uncertainty.

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Action

59. To remedy the injustice caused by the faults identified, the Council has agreed to complete the following within one month of the final decision:

• apologise in writing to Miss Y and Mrs X to acknowledge the injustice caused by the Council’s failings as identified above. The apology should be in accordance with our guidance, Making an effective apology
• make Miss Y a symbolic payment of £500 in recognition of the distress and uncertainty caused by the Council’s failings as identified above
• offer Miss Y a carer’s assessment to identify and support her carer’s needs.

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

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Decision

61. I find some faults by the Council causing injustice to Miss Y. The Council will take action to remedy the injustice caused.

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Investigator's decision on behalf of the Ombudsman