Summary: Miss X complained about the Council’s actions following her annual review. We find fault in the Council’s failure to provide copies of final assessments in a timely way, its poor communication and complaint handling, and its failure to clearly act on or explain decisions following the January 2025 review. I also found fault in the Council’s handling and recording of contingency planning in relation to Miss X’s upcoming surgery. These faults caused Miss X avoidable distress, uncertainty, and time and trouble in pursuing information and support. The Council has agreed to apologise, make a payment to Miss X, and take steps to improve its services.

The complaint

1. Miss X complained about the Council’s actions following her annual review. In particular, she says the Council:
1. failed to provide her with a copy of her care and support assessment or care plan;
2. arranged an unnecessary repeat assessment;
3. did not clearly explain its contingency arrangements; and
4. communicated poorly and included inaccurate information in its complaint response.
2. She says these issues caused her distress and uncertainty.

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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. 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 Miss X and the Council as well as relevant law, policy and guidance.
7. Miss 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 legislation

Reviews

8. 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.

Direct payments

9. 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.

What happened

10. Miss X receives direct payments to meet her eligible care and support needs. These payments are paid into a shared account which also receives direct payments for a family member.
11. In January 2025, the Council completed an annual review of Miss X’s care and support plan. During the review, Miss X asked for an increase in her support hours so she could better access the community and made the Council aware of upcoming surgery she is due to have.
12. In February and March, Miss X contacted her allocated social worker to request an update on her request for increased support. She did not receive a response.
13. In late March, Miss X made a formal complaint to the Council. She raised concerns about poor communication from her social worker, who she said had not contacted her since the January review. She explained that she did not have the support she needed and was struggling to manage her care. She asked the Council for an urgent update.
14. In April, the Council telephoned Miss X in response to her complaint. It explained that her social worker had been absent from work and had not written up the January review before going off. The Council offered to arrange a further review of Miss X’s care and support needs. Miss X declined this offer, as she considered a full review had already been completed in January.
15. Later that month, Miss X contacted the Council after receiving a letter advising that the hourly rate for personal assistants had increased and inviting direct payment recipients to contact the Council if they required an increase. The Council internally confirmed that Miss X was entitled to the increased hourly rate but decided no adjustment was needed because there was a surplus in the direct payment account. The Council did not communicate this decision to Miss X.
16. In May, the Council issued its stage one complaint response. It said Miss X’s social worker had been absent from work since February and had an out-of-office message in place providing alternative contact details. It said it had offered Miss X a new review, but as she had declined this, it was unable to consider her request for increased support. The Council also said Miss X’s care plan included 25 hours per week for community access, that her direct payment account showed a surplus, and that the social worker had returned to work, written up the January review, and would contact Miss X within the next week.
17. Dissatisfied with the response, Miss X escalated her complaint. She said she had not received an out-of-office response to her emails and had received no reply following her contact in April. She said her care plan only included four hours per week for community access and that she had requested an additional three to four hours due to her deteriorating health. She explained that the surplus in the direct payment account related to her family member, not her own care. Miss X also said she was due to undergo surgery in the coming months and would need to use her surplus in the account to fund additional support during her recovery. She asked the Council to carry out a full reassessment, approve the increase in care, acknowledge errors in the stage one response, ensure staff set out-of-office replies when absent, and explain how her support would be increased in preparation for her surgery.
18. In June, the Council issued its final complaint response. It acknowledged it had incorrectly stated that Miss X received 25 hours per week for community access. It said it had now sent her a copy of the January review and confirmed a reassessment had been arranged for later that month, during which her upcoming surgery and use of the surplus in the direct payment account could be discussed. It said it would consider her request for increased hours following the reassessment.
19. Miss X then brought her complaint to the Ombudsman.
20. In response to my enquiries, the Council said it was unable to provide evidence of any out-of-office replies sent to Miss X in February and March 2025, as these are not retained for longer than 30 days.
21. The Council confirmed that Miss X’s reassessment took place over two meetings in June and July 2025. It sent Miss X a draft assessment, which she confirmed was accurate. The assessment was then finalised, but the Council did not send the final version to Miss X because no changes had been made from the draft.
22. The Council confirmed that, following the reassessment, it agreed to provide Miss X with an additional three hours per week to support her access to the community on a temporary basis from October 2025.

My findings

Sharing of assessments and care and support plans

23. Evidence shows the Council did not provide Miss X with copies of her final care and support assessments completed in January and July 2025.
24. The Council explained it did not send Miss X a copy of the final July assessment because no changes were made between the draft and the final version. I do not consider this to be a good reason. Once an assessment or care and support plan is finalised, councils should provide the individual with a copy, so they have a clear and accurate record of their assessed needs and agreed support.
25. The Council’s failure to share the final assessments in a timely way was fault. This caused Miss X uncertainty about her care arrangements and required her to spend time and effort pursuing information that should have been provided as a matter of course.

Repeat assessment and consideration of increased support

26. In April 2025, the Council offered to complete a further assessment because Miss X’s January review had not been written up by her social worker before they were absent from work. As a result, the Council said it could not progress Miss X’s request for increased support hours at that time.
27. I accept that, at that point, the Council’s offer of a further assessment was intended to ensure Miss X could be supported without further delay. However, Miss X declined this offer as she considered a full review had already taken place.
28. Miss X’s social worker returned to work around May 2025 and subsequently wrote up the January review. It is therefore unclear why the Council did not then consider Miss X’s request for additional support based on the January review, particularly as her requests remained the same: increased support to access the community and additional support in relation to her upcoming surgery.
29. The January review should have provided sufficient information for the Council either to decide on Miss X’s request or to clearly explain why a full reassessment was required due to a change in her needs. The Council failed to do either. This was fault.
30. The Council later agreed a temporary increase in support following a full reassessment finalised in July 2025. This decision was made in October 2025, after Miss X had brought her complaint to the Ombudsman. As this followed a reassessment outside the scope of my investigation, I cannot say whether Miss X would have been eligible for the increased support had the January review been finalised and acted on without delay. I also cannot make a finding on the time taken between the July reassessment and the October decision, as this also falls outside the scope of my investigation.
31. However, the Council’s failure to act on the January review or to clearly communicate why a further reassessment was necessary after her social worker returned to work caused Miss X avoidable frustration, uncertainty, and delay.

Contingency planning for surgery

32. Miss X told the Council in January 2025 that she was due to have surgery and would require additional support during and after this period. This was also discussed during the reassessment started in June 2025.
33. The written records state that Miss X had not yet considered aftercare following her surgery. However, Miss X’s complaint correspondence shows she was asking the Council about additional support around this time. Records also show some confusion around who the surplus in the direct payment account belonged to.
34. Based on the evidence, I cannot say, on the balance of probabilities, whether contingency arrangements for Miss X’s surgery were sufficiently discussed and agreed. However, it is clear that Miss X remained unclear about what support would be in place when her surgery occurred.
35. Either the Council failed to adequately discuss and agree contingency arrangements with Miss X, or relevant discussions were not properly recorded. In either case, this was fault and caused Miss X uncertainty.

Communication and complaint handling

36. Miss X contacted her social worker in February and March 2025 but did not receive a response. The Council said out-of-office replies were in place during the social worker’s absence. However, it has since confirmed out of office replies are not retained after 30 days. As the Council provided its complaint response to this matter 60 days after Miss X’s most recent contact in March, I am not satisfied that the Council can be assured that an out-of-office reply was sent.
37. During the social workers absence, the Council should have had appropriate managerial oversight of open cases and ensured affected service users were informed and given an alternative point of contact. Its failure to do so was fault and represented a missed opportunity to prevent Miss X’s complaint.
38. The Council has acknowledged it failed to respond to Miss X’s contact in April 2025 regarding the increase in personal assistant hourly rates and her direct payment. This was fault and caused Miss X further distress and uncertainty.
39. The Council’s stage one complaint response also included inaccurate information, including incorrectly stating the number of hours Miss X received to support community access. This was fault and caused Miss X avoidable time and trouble in continuing to pursue her complaint.

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Action

40. To remedy the injustice caused by the above faults, within four weeks of the date of my final decision, the Council has agreed to:
• apologise to Miss X in line with our guidance on Making an effective apology; and
• pay Miss X £300 to recognise the distress, uncertainty, and time and trouble caused by its failures to communicate effectively, to share assessment documents in a timely way and to act promptly on the January 2025 review.
41. Within three months of the date of my final decision, the Council has agreed to:
• remind relevant adult social care staff of the importance of providing service users with copies of finalised assessments and care and support plans, even where no changes have been made from draft versions; and
• review its arrangements for managing cases when social workers are unexpectedly absent, including ensuring appropriate managerial oversight and clear alternative contact arrangements for service users.
42. The Council should provide us with evidence it has complied with the above actions.

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Decision

43. I find fault causing injustice. The Council has agreed actions to remedy injustice.

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Investigator's decision on behalf of the Ombudsman