Summary: Mr X complained on behalf of his mother, Mrs X, that the Council failed to properly assess her needs before it reduced her Direct Payment funded care package following a review of her care and support needs. The Council reached a reasoned professional judgement about Mrs X's eligible care and support needs. There was no fault found in the Council’s decision-making process.

The complaint

1. Mr X complained the Council reduced his mother's Direct Payment funded care package from 16.75 hours per week to 8 hours per week following a review of her care and support needs. He says the Council failed to properly assess her needs before reducing her support.
2. Mr X says the reduced care package does not reflect Mrs X's care and support needs, placing her at risk of self-neglect and causing distress and uncertainty for Mrs X and her family.

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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 Mr X and the Council as well as relevant law, policy and guidance.
6. 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 found

Relevant legislation and guidance

Reviews

7. 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

8. 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

9. Mrs X has received support from Adult Social Care for several years. The Council assessed Mrs X as requiring a Direct Payment funded package of approximately 16.75 hours per week following a Care Act review completed in July 2023.
10. The family requested a further review in October 2024 because they considered Mrs X's care needs had increased. Mrs X was diagnosed with Alzheimer's disease during the review period.
11. A review of Mrs X's care and support needs took place in early November 2024. The Council recorded information during the review about Mrs X's physical health, depression, cognition, daily living needs and the support provided by her family. The Council also discussed concerns regarding Mrs X's overnight needs and agreed further evidence should be obtained before determining whether additional support was required.
12. The Council sought information from Mrs X's day service regarding her daily functioning. It also discussed Mrs X's circumstances with Mr X and his wife, attempted to obtain information from the community nursing team and sought information from the specialist memory service following notification of Mrs X's Alzheimer's diagnosis.
13. The Council arranged for an occupational therapist to assess Mrs X in February 2025. The assessment included observations of Mrs X completing aspects of her morning routine, including mobility, transfers, toileting, dressing and personal care. The occupational therapist also considered information provided by Mr X and his wife regarding the support they provided throughout the day and during the night.
14. The occupational therapist concluded Mrs X remained independent with mobility, transfers and toileting but continued to require prompting and support with medication, applying creams, organising clothing, meal preparation and bedtime routines. The occupational therapist recommended reducing the commissioned care package to two 30-minute visits each day and considered 15-minute visits would not adequately meet Mrs X's needs because of her cognitive impairment.
15. The Council also considered information obtained from the day service, which indicated Mrs X independently used the toilet whilst attending, required encouragement to participate in activities at times and was generally able to manage her continence independently.
16. The Council considered information regarding Mrs X's overnight activity, including telecare monitoring records. It concluded that whilst the records showed Mrs X frequently got out of bed during the night, they did not establish that she required commissioned overnight personal care.
17. The Council completed the review of Mrs X's care and support needs in February 2025 and reduced her Direct Payment funded support package from 16.75 hours per week to 8 hours per week.
18. Mr X complained. He said the assessment focused mainly on Mrs X's physical abilities and failed to properly recognise the impact of her depression, Alzheimer's disease, cognitive impairment and need for prompting, supervision and encouragement. The Council considered the complaint through each stage of its complaints procedure but maintained its decision.

Analysis and findings

19. The Ombudsman is not an appeal body. This means we do not take a second look at a decision to decide if it was wrong. Instead, we look at the processes an organisation followed to make its decision. If we consider it followed those processes correctly, we cannot question whether the decision was right or wrong, regardless of whether you disagree with the decision the organisation made.
20. Mr X complained the Council's assessment placed too much emphasis on Mrs X's physical abilities and failed to properly recognise the impact of her depression, self-neglect, Alzheimer's disease and cognitive impairment.
21. The evidence shows the Council completed a comprehensive reassessment before reaching its decision. It gathered information from several sources, including the Care Act review, the occupational therapy assessment, the day service, Mr X and his wife, and other health professionals where appropriate. The Council also considered Mrs X's recent Alzheimer's diagnosis as part of the review.
22. The occupational therapy assessment was not limited to Mrs X's physical abilities. It considered her medical conditions, cognitive impairment, communication needs, living arrangements, family support and daily functioning. The assessment distinguished between tasks Mrs X could complete independently and those where she continued to require prompting or support. It also recognised that, because of her cognitive impairment, 15-minute care visits would not be sufficient.
23. Mr X also complained the Council failed to properly consider Mrs X's overnight needs. The evidence shows the Council responded to those concerns by obtaining telecare monitoring information and considering it alongside observations made during the review, the occupational therapy assessment and information from the day service. Whilst the telecare records demonstrated Mrs X regularly got out of bed during the night, they did not establish that she required commissioned overnight personal care. The Council was entitled to weigh that evidence together with the other information available when determining Mrs X's eligible needs.
24. This investigation also considered whether the Council reduced Mrs X's support based on assumptions about how quickly a commissioned care provider could complete tasks, rather than on a reassessment of her eligible needs. Whilst the occupational therapy assessment notes that a commissioned care worker may complete tasks more quickly than the existing Direct Payment arrangement, the overall assessment demonstrates the recommendation was based mostly on direct observation of Mrs X's needs and functioning.
25. The evidence showed the Council followed a proper assessment process, considered the relevant information and reached a reasoned professional judgement about Mrs X's eligible care and support needs.
26. It is appreciated the reduction in Mrs X's care package has been upsetting for Mr X and his family, particularly given the support they continue to provide. However, the Ombudsman cannot question a council's professional judgement where it has followed the correct process and considered the relevant information before reaching its decision.
27. This investigation found no fault in the way the Council reviewed Mrs X's care and support needs or reached its decision to reduce her Direct Payment funded support package.

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Decision

28. I find no fault.

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Investigator's decision on behalf of the Ombudsman