Summary: Miss X complained about the Council’s alleged failure to meet her assessed care and support needs and about the standard of care provided to her by the Council’s commissioned domiciliary care providers. There was fault by the Council for its delays with reassessing Miss X’s care needs and with implementing her agreed direct payment managed account. This caused injustice to Miss X. The Council will take action to remedy the injustice caused.

The complaint

1. Miss X complained about the Council’s alleged failure to meet her assessed care and support needs and about the standard of care provided to her by the Council’s commissioned domiciliary care providers.
2. Miss X said the matter caused and continued to cause her extreme anxiety, stress, frustration and affected her health and quality of life. Miss X also said she had not received care support for several months.

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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. 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)
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. I have not exercised discretion to investigate matters from 2023. These are late complaints and I find it was reasonable for Miss X to have complained about these matters to us sooner. There are no good reasons to investigate them now.
9. I have investigated matters from September 2024 to September 2025. This covers the 12-month period from when Miss X made a complaint to the Ombudsman.

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How I considered this complaint

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

Care Assessments and Plans

12. 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.
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. 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

15. 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

16. 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.
17. After considering the suitability of the person requesting direct payments against the conditions in the Care Act 2014, the council must decide whether to provide a direct payment. In all cases, the council should consider the request as quickly as possible.
18. The council must provide interim arrangements to meet care, and support needs to cover the period in question. Where accepted, the council should record the decision in the care or support plan. Where refused, the council should explain its decision in writing to the person who made the request. It should also tell the person how to appeal against the decision through the local complaints procedure. (Care and Support Statutory Guidance 2014)

Background

19. In 2023, the Council completed a care needs assessment for Miss X and found she was eligible for care support. The Council placed Miss X in a care home on a temporary basis.
20. In early 2024, due to Miss X’s increased care needs, the Council changed her care package to permanent domiciliary care. Miss X’s care package was provided to her by a Council commissioned care provider.

Key events

2024

21. In September, Miss X said her medical professional told her some care protocols had to be followed few weeks before and after her scheduled surgery to prevent the risk of infection. These protocols included use of masks, gloves and shoe covers.
22. After Miss X had a surgery, the Council re-assessed her care needs and agreed to increase her care package which included:

• Morning Care Call (1 hour)
• Lunch Care Call (30 minutes)
• Evening Care Call (30 minutes)
• Deep Cleaning Care Call (1 hour per week)
• All personal protective equipment (PPE) must be worn.

23. A Council commissioned care provider (CP1) delivered the domiciliary care package to Miss X.
24. In November 2024, Miss X raised concerns with CP1 and the Council about the carers’ lateness, failure to use PPEs, refusal to provide her with care and their abusive/disrespectful conduct. Miss X asked the Council to change CP1.
25. The Council discussed Miss X’s concerns with CP1, and it confirmed all necessary protocols were observed. CP1 said as an added measure it would reiterate protocol compliance with the carers and it would complete regular checks to ensure the carers met the required care standards.
26. In December, CP1 raised concerns about Miss X’s conduct towards the carers, and it told the Council it wanted to terminate its contract. Miss X also continued to raise concerns about the carers’ unprofessional conduct.
27. The Council explored alternative care options for Miss X. In mid-December, the Council discussed and offered the option of direct payments with Miss X, and it gave her the relevant paperwork to sign. Miss X said she would discuss the matter with her legal representative.
28. The Council asked CP1 if it could continue providing Miss X’s care package while it looked to commission another care provider and CP1 agreed.
29. Towards the end of December, CP1 informed the Council that Miss X refused the carers entry to her home on a couple of days. The Council told Miss X she was placing herself at risk by declining the care.

2025

30. In January, CP1 terminated its contract due to relationship breakdown between it and Miss X. The next day, the Council commissioned another care provider (CP2) for Miss X.
31. Between January and April, the Council commissioned two care providers to deliver Miss X’s care package, CP2 (from January to March) and CP3 (from March to April). There were no gaps in the delivery of Miss X’s care package.
32. During the above periods, Miss X raised concerns about both care providers’ punctuality, staff changes, the standard of care provided and failure to use PPEs. Both CP2 and CP3 also raised concerns and made formal complaints about Miss X’s conduct towards their respective staff (her carers). The Council discussed and wrote to Miss X with the expected standard of engagement with the care providers.
33. CP2 and CP3 both terminated their contracts in March and April respectively, due to Miss X’s conduct, her refusal/cancellation of care calls and relationship breakdown between the commissioned care providers and Miss X.
34. In April, Miss X stopped receiving her care package. She told the Council that a relative and a friend had supported her temporarily since CP3 ended its contract. Miss X said she was struggling as she no longer had any support and she asked the Council to re-assess her care needs.
35. The same month, Miss X told the Council she wanted to source a private carer which she had identified (CP4). The Council explained to Miss X that it would not pay for private carers but advised that she could pay for them through agreed direct payments. The Council referred Miss X to their direct payments discussion in mid-December 2024 and asked her to sign and return the relevant paperwork it gave to her.
36. Miss X told the identified private carer (CP4) not to start providing her with her care package until a meeting with her social worker had taken place because she felt she required more care hours. CP4 said Miss X maintained her stance even after it offered to start providing her with her current care package at the time until an increment was agreed with the Council. Miss X signed and submitted the direct payment paperwork to the Council.
37. In mid-June, Miss X’s allocated social worker met with her to discuss direct payments which was her preferred option so she could get CP4 to start providing her with care. The outcome of the meeting was that a care needs reassessment was to be completed and for direct payments to be considered/arranged to support the delivery of her care package.
38. In July, the Council held a meeting with Miss X and CP4. The Council reassessed Miss X’s care needs and it was agreed in Miss X’s support plan that she would receive direct payment service for private carers of her choice to provide her with 24.5 hours of care per week.
39. In August, Miss X informed the Council she was due to have a surgery soon and she asked the Council to arrange CP4 to start providing her with her care package as soon as possible.
40. The Council attempted to contact CP4 and in early September, it sent an email to CP4 explaining Miss X was due to be admitted to hospital for a surgery. The Council explained that in this situation, the hospital social work team would be required to complete an assessment once Miss X was medically fit for discharge. It said the hospital social work team would also be responsible for implementing Miss X’s initial care package. The Council said as a result, it would be unable to progress Miss X’s case for a direct payment managed account by CP4 at that stage. The Council asked CP4 to explain the situation to Miss X.
41. The Council did not implement Miss X’s direct payment managed care while it awaited clarification on her hospital admission/surgery.
42. In September, the Council confirmed Miss X was not admitted to the hospital. Miss X told the Council that she had to cancel her surgery because she did not have a care package and/or carers in place which she would have needed post-surgery. Miss X expressed her dissatisfaction and frustration with how the Council had handled her case and she asked it to provide her with care. There was no evidence to show why Miss X’s surgery was cancelled.

Miss X’s complaints

43. Miss X made a formal complaint to the Council about the standard of care provided to her by the Council’s commissioned care providers which was why she cancelled her care package with the care providers. Miss X complained she had been left without care since April 2025 and that the Council had failed to complete a care needs reassessment for her as requested. Miss X told the Council she was in urgent need of care support.
44. In its responses to Miss X’s complaint, the Council:

• explained how it commissioned different care providers to deliver her care package, but they all terminated their contracts due to relationship breakdown.
• Miss X refused to let her care package be delivered by CP4 until she had a meeting with a social worker.
• said it had offered Miss X the direct payment option, but she had told the Council she wanted to seek legal advice
• apologised for its delays with completing a care needs reassessment for her.

45. Miss X remained dissatisfied with the Council’s responses, and she made a complaint to the Ombudsman. Miss X said the Council had still not provided her with her care package from April 2025 to September 2025.
46. In response to our enquiries, the Council said its delays with arranging Miss X’s care and direct payments were due to hospital pathway requirements, care provider availability and direct payments administrative processes.

Analysis

47. Between September 2024 and mid-April 2025, the Council commissioned different care providers (CP1, CP2 and CP3) to provide Miss X with her care package. This was not fault. All the commissioned care providers terminated their contracts due to their respective relationship breakdown with Miss X. I am satisfied the Council took reasonable steps to resolve concerns raised by all parties involved, find alternative care providers for Miss X and to ensure she was not left without care during this period.
48. Councils complete care act assessments and/or reassessments 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. In this case, after Miss X requested a reassessment of her care needs, the Council took approximately three months to complete the reassessment (April 2025 – July 2025). This was fault.
49. I note the Council’s point about the hospital being responsible for surgical procedure care and post-surgery care. However, the Council remained responsible to have ensured it had put in place Miss X’s agreed direct payment managed account after it completed her care needs reassessment in July 2025. This was fault.
50. Had the Council put in place Miss X’s direct payment managed account and had she gotten admitted to the hospital and proceeded with her surgery, the managed account would have remained active. Although, in that instance the Council would have suspended any direct payments to CP4 for the period Miss X would have been admitted to the hospital. Therefore, Miss X’s anticipated hospital admission/surgery did not absolve the Council of its duty to have put in place Miss X’s direct payments managed account in a timely manner (August 2025 – September 2025). This was fault.
51. The Council’s delays with completing Miss X’s care needs reassessment and its delays with putting in place her direct payment managed account was fault. It caused distress, worry and uncertainty to Miss X. The Council’s delays also meant Miss X’s care needs were not promptly identified and she was left without the care and support required to have met her identified needs from mid-April 2025 to September 2025.

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Action

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

• apologise in writing to Miss X to acknowledge the injustice caused to her by the Council’s identified faults as set out above. The apology should be in accordance with our guidance, Making an effective apology
• make Miss X a symbolic payment of £500 to acknowledge the loss of the agreed care and support she missed out on between mid-April 2025 and September 2025 caused by the Council’s failings as identified above
• put Miss X’s direct payment managed account in place to ensure she receives the identified care and support required to meet her care needs
• review its processes to ensure direct payments are put in place as soon as possible or to ensure a commissioned service is put in place if there are circumstances which are causing delays to the provision of direct payments. This is to ensure there are no gaps in service users’ care provision.

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

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Decision

54. I find fault by the Council causing injustice to Miss X. The Council has agreed actions to remedy the injustice caused.

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Investigator's decision on behalf of the Ombudsman