Summary: The Council acknowledged failings in the way it dealt with the assessment and care planning for Miss Y before the involvement of this office, but it failed to provide an adequate remedy for the injustice caused to Miss Y and her mother.

The complaint

1. Ms X complains about the way the Council dealt with the assessment and care planning for her adult daughter, Miss Y, between 2022 & 2025. She also complains about the way the Council handled an application for direct payments.

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The Ombudsman’s role and powers

2. 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)
3. 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

4. I have considered all the information provided by Ms X together with the Council’s response to the complaint and information provided by the Council to this office. I have also taken account of relevant legislation. Both Ms X and the Council had the opportunity to comment on a draft of this document.

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What I found

Relevant legislation

5. Councils must carry out an assessment for any adult with an appearance of need for care and support. 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 involve the individual and where suitable their carer and any other person they may want to involve. (Care Act 2014, Sections 9 and 10)
6. A council must carry out the assessment over an appropriate and reasonable timescale considering the urgency of needs and any variation in those needs. It should keep the person updated throughout the assessment. (Care and Support Statutory Guidance 2014, Paragraph 6.24)
7. If the needs assessment identifies eligible needs, the council will provide a support plan setting out what services are required to meet these needs.
8. Everyone whose needs the council meets must receive a personal budget as part of the care and support plan. The personal budget gives the person clear information about the money allocated to meet the needs identified in the assessment and recorded in the plan. The council should share an indicative amount with the person, and anybody else involved, at the start of care and support planning. It should confirm the final amount of the personal budget through this process. The detail of how the person will use their personal budget will be in the care and support plan. The personal budget must always be enough to meet the person’s care and support needs.
9. There are three main ways a personal budget can be administered: as a managed account held by the council with support provided in line with the person’s wishes; as a managed account held by a third party (often called an individual service fund or ISF) with support provided in line with the person’s wishes; or as a direct payment. (Care and Support Statutory Guidance 2014)
10. The Care and Support Statutory Guidance says, “Local authorities should ensure that the method used for calculating the personal budget produces equitable outcomes to ensure fairness in care and support packages regardless of the environment in which care and support takes place, for example, in a care home or someone’s own home.
11. A council should be able to show the personal budget is sufficient to meet the eligible care needs set out in the care plan, and that it has not fettered its discretion by setting a ceiling on what it will pay for 24-hour care (typically the equivalent of cost of residential care).

Background

12. Miss Y is in her twenties and at the time of the complaint lived with Ms X. Ms X provides Ms Y with emotional and practical support alongside her own full-time employment.
13. The Council completed an assessment of Miss Y’s care and support needs in April 2022. Following this Ms X says she had no further communication from the Council. She did not receive a care plan for Miss Y until June 2024.
14. Ms X complained to the Council. The Council allocated a social worker to Miss Y in November 2024. Ms X says the social worker verbally informed her that Miss Y would not have to make a financial contribution towards her care.
15. Miss Y requested a direct payment to purchase care and support. Direct payments were agreed by the Council in December 2023. Ms X says the payments were not progressed further until April 2024.
16. In June 2024 Miss Y received her first direct payment, she also received a lump sum for payments backdated to January 2024. Ms X says there was a delay in the Council making a referral to an agency providing support with direct payment administration.
17. In July 2024, the Council completed a financial assessment of Miss Y and subsequently informed Ms X, that Miss Y was required to make a financial contribution towards her care. The Council backdated the contribution to January 2024 and requested payment of £3,000, which Ms X paid.
18. Ms X believed the allocated personal budget to be insufficient to meet both Miss Y’s needs cover the associated administration costs. Ms X was unable to pay the hourly rate agreed with Miss Y’s personal assistant because when she agreed that rate with the Council she did not realise the amount included the cost of holidays/sickness, tax ect. Consequently, Miss Y was without support during the periods her personal assistant was absent due to holidays/sickness, which Ms X estimates to be 5/6 weeks. Ms X also says she funded the cost of public liability insurance from her own personal funds. She also believed the Council had not fairly assessed Miss Y’s disability related expenditure.
19. Ms X complained to the Council in June & August 2024. The Council provided a complaint response in September 2024 and acknowledged failings in the following areas:

• delays in completion of assessment and care planning documentation and delay in providing Ms X with copies;
• delay in completing a financial assessment for Miss Y;
• delay in dealing with Ms X’s appeal about the outcome of a financial assessment;
• delay in a referral to an agency providing direct payment administration support;
• the hourly rates for Miss Y’s personal assistant;
• poor communication from a social worker.

20. The Council apologised and explained the actions it had taken to prevent a reoccurrence, which included staff training. The Council allocated Miss Y a different social worker to address the financial aspects of her personal budget.
21. Ms X remained dissatisfied with the Council’s position on disability related expenditure. She believed the Council had unfairly refused some costs and appealed the decision.
22. The Council provided Ms X with a detailed response in January 2025. It explained how each request had been considered, which requests had been approved, and which had not.
23. Ms X remained dissatisfied and submitted a complaint to this office in March 2025.

Miss Y had a stroke July 2025, following which the Council allocated a different social worker. Ms X is complimentary about both this social worker’s approach and the subsequent actions taken, which she and Miss Y are satisfied with. Miss Y now receives additional support hours and an increased personal budget. The hourly rate for her personal assistant has been uplifted to take account of accrual for holidays and sickness.

24. The Council reviewed Miss Y’s financial assessment again in July 2025 and reconsidered Ms X’s request that specific expenditure be considered as disability related expenditure. Some costs were agreed, some were refused, and further evidence was requested for others.

Findings

25. The Council acknowledged numerous failings in the service provided to Miss Y and Ms X before the complaint came to this office. It identified areas of service improvement and formally apologised. However, this is not a sufficient remedy for the prolonged injustice caused to Ms X and Miss Y between 2023 & 2025.
26. Following intervention from this office, the Council agreed the actions set out below.
27. In respect of disability related expenditure, I find no fault by the Council here. It gave due consideration to the requests and adequately explained what can & cannot be included.

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Agreed Action

28. The Council agreed to:

• confirm if, and for how long Miss Y missed out on formal support and add these hours to her current support package free of charge;
• confirm and calculate any payments made by Ms X to cover employer liabilities, and reimburse any payments made;
• pay Ms X £500 – made up of £250 for time & trouble & £250 to acknowledge stress and worry.

29. The above actions should be completed within four weeks of the final decision, and evidence of this provided to this office.

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Final Decision

30. The Council acknowledged failings in the way it dealt with the assessment and care planning for Miss Y before the complaint came to this office, but it failed to provide an adequate remedy for the injustice caused to Ms X and Miss Y.
31. The above actions are a suitable way to remedy to settle the complaint.
32. It is on this basis; the complaint will be closed.

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Investigator's decision on behalf of the Ombudsman