Summary: There is no evidence the Council properly considered the risk of falls before it reduced the number of Ms X’s daily care visits. This is fault. There is no fault in how the Council assessed Ms X’s finances. The Council has agreed to apologise, pay Ms X £100, and review her care plan.

The complaint

1. Ms X complains about the way the Council has handled her care and support. In particular, that the Council has:
1. reduced the number of care visits she receives from three a day to one a day.
2. not properly assessed her finances and so she is paying more for her care than she can afford.
2. Ms X says this has caused her financial hardship and is having an impact on her mental health.

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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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. If we are satisfied with a council’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended)

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How I considered this complaint

5. I considered the complaint and the information Ms X provided.
6. I made written enquiries of the Council and considered its response along with relevant law and guidance.
7. I referred to the Ombudsman’s Guidance on Remedies, a copy of which can be found on our website.
8. Ms X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Adult Social Care – Assessment

9. Sections 9 and 10 of the Care Act 2014 require local authorities to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to all people regardless of their finances or whether the local authority thinks an individual 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.
10. The Council must carry out the assessment over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Local authorities should tell the individual when their assessment will take place and keep the person informed throughout the assessment.
11. The Care Act 2014 gives local authorities a legal responsibility to provide a care and support plan (or a support plan for a carer). The care and support plan should consider what 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 local authority must involve any carer the adult has. The support plan may 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.

Adult Social Care – Charging

12. Councils can make charges for care and support services they provide or arrange. Charges may only cover the cost the council incurs. (Care Act 2014, section 14)
13. Councils must assess a person’s finances to decide what contribution they should make to a personal budget for care. The scheme must comply with the principles in law and guidance, including that charges should not reduce a person’s income below a Minimum Income Guarantee. The Council can take a person’s capital and savings into account subject to certain conditions. If a person incurs expenses directly related to any disability they have, the Council should take that into account when assessing their finances.

What happened

14. Ms X has care and support needs. The Council provides her with care and support.
15. At first, a member of Ms X’s family paid her assessed contribution to her care costs. However, in February 2019 this family member was no longer able to pay for Ms X’s care.
16. The Council reassessed Ms X’s finances as a result. It determined she could afford to pay a weekly contribution towards the cost of her care.
17. Ms X had three visits a day from carers. The Council reviewed Ms X’s care and support in January 2020. The resulting Care Plan says the carers supported Ms X to wash, dress, prepare meals and drinks, take medication and attend to household tasks.
18. In July 2020, the Council reviewed Ms X’s care and support needs and said Ms X “has expressed that she wants a carer in the morning only for the duration of 40 minutes. She does not want a call for the evening”.
19. As a result, Ms X’s care visits reduced to one a day, in the morning. Ms X says she did not agree to this decrease in visits.

My findings

Fewer care visits

20. The Care Plan review expressed that it is Ms X’s wish to reduce to one visit a day. Ms X says this is not the case.
21. The Council’s record of a conversation with Ms X in June 2020 shows that Ms X said she needed a longer care visit in the mornings. The record says Ms X suggested that an extra 10 minutes for the morning visit could be found if the tea-time call was cancelled. The 10-minute care call at teatime was for carers to help Ms X get ready for bed. Ms X told the Council that she had friends who visited in the evening who would help her to do this. I have no reason to doubt the accuracy of this record. Therefore, I find that Ms X did suggest the reduction in care visits to two visits a day.
22. The Council’s assessment of Ms X’s care and support needs from January 2020 says she is at risk of malnutrition and dehydration. It says this risk is managed by carers helping with meals and drinks. The Council removed the lunchtime call because it found that Ms X wasn’t making use of it.
23. The Council provided evidence to show that the carers were not, in practice, required to help Ms X with a meal at lunch time because she preferred to have a protein drink. This demonstrates the Council considered Ms X’s risk of malnutrition before removing the lunch-time call.
24. However, the assessment records that Ms X is at high risk of falls. The Care Plan says one of the tasks for the carers on each visit is to ensure Ms X is wearing her falls detector. The January 2020 review also says Ms X “is happy with the carers and find[s] their support indispensable to maintain her overall health and wellbeing.”
25. The July 2020 review was a ‘light-touch’ review. This is intended to be reactive and allow changes to the care plan more quickly than a full review. To conduct a light-touch review is not fault. However, any changes must be made with the identified risks in mind. Although it properly considered the risk of malnutrition, the Council’s review of Ms X’s Care Plan in July 2020 does not say how the risk of falls will be managed with one care visit a day. This is fault.
26. It may well be that the Council is satisfied that the risk is appropriately managed with a morning call in addition to the informal support Ms X has from her community. However, the Council’s failure to explain how the new Care Plan will manage the risk of falls identified in the January 2020 assessment means there is uncertainty about whether the Care Plan can meet Ms X’s needs and keep her safe. This is an injustice to Ms X.
27. The Council should explain to Ms X how it decided that the risks identified in her Care Plan can be met by the care in place. The Council should consider amending the light touch review documentation to ensure identified risks are considered and recorded as part of light touch reviews.

Charging

28. The Council can require people to pay towards the cost of their care and support, provided doing so would not leave them without enough money to live on.
29. The Council must disregard certain income and take into account any Disability Related Expenses (DREs) when calculating what someone can afford to pay.
30. Ms X’s finances are such that she is expected to contribute a weekly amount towards the costs of her care. The Council uses a financial assessment to work this out.
31. The Council started a new financial assessment in February 2019 when Ms X’s family member could no longer pay her contribution. This new assessment did reduce Ms X's weekly contribution, however she says she cannot pay it.
32. Before 2019, the Council included a DRE for incontinence aids in Ms X’s assessment. After April 2019, it no longer included this DRE. The Council says this is because Ms X did not provide the evidence it asked for to confirm the expense. Ms X says she provided receipts for this with the other evidence she provided.
33. Since the Council’s earlier assessments included this DRE, it must previously have been satisfied she had this expense. In the February 2019 assessment, however, Ms X reported a much higher figure for the cost of her incontinence products. It was not fault for the Council to ask for evidence to verify this.
34. The Council asked Ms X to provide evidence of her DREs on more than one occasion. On balance, I find this is because either Ms X had not provided it or else the Council did not receive it. It also wrote to Ms X’s GP for confirmation of any incontinence need. In December 2019, the GP confirmed that Ms X had no diagnosed continence issues.
35. I find no fault with how the Council removed the DRE for incontinence products. Ms X had several opportunities to provide evidence to the Council of the cost of these products and failed to do so. If, as she says, she did provide evidence of her incontinence costs, given the Council said it still needed these, Ms X could have provided them again.
36. It is open to Ms X to ask the Council to conduct a new review of her financial contribution. Ms X should provide any evidence necessary to establish her DREs.
37. If Ms X asks for a further review and previously removed DREs are evidenced, the Council can consider whether to backdate these.
38. Ms X has accrued significant arrears in her assessed contribution since February 2019. She has not made any payments. I do not find any fault with how the Council assessed her finances that would suggest Ms X should not have been paying anything at all towards the cost of her care.
39. Ms X is struggling to manage her finances effectively to meet her financial obligations. The Council says it has offered Ms X support with this. The Council could consider offering or referring her for some specific support around budgeting to help Ms X identify how she can make sure she meets the cost of her care. It is up to Ms X whether she accepts this support.

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Agreed action

40. To remedy the injustice to Ms X from the fault I have identified, the Council has agreed to:
• Apologise to Ms X in writing
• Pay Ms X £100 in recognition of her avoidable uncertainty and distress
• Review Ms X’s Care Plan to ensure all the identified risks are managed
41. The Council should take this action within four weeks of my final decision.
42. The Council should also take the following action to improve its services:
• Consider amending the ‘light-touch’ review form to ensure the risks identified by the care assessment are properly considered as part of any change to care and support.
43. The Council should tell the Ombudsman about the action it has taken within three months of my final decision.

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Final decision

44. I have completed my investigation. There is some fault by the Council. The action I have recommended is a suitable remedy for the injustice caused.

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Investigator's decision on behalf of the Ombudsman