Summary: Ms B says the Council does not provide enough money to meet Mr C’s adult social care needs. The Council has acted correctly to assess care and support needs and provide a personal budget for live in care. The Council gives Mr C the money as direct payments. Mr C chooses to use his budget to employ personal assistants rather than a live in carer, which is more costly and means his budget does not stretch as far. This is his choice and is not fault of the Council.

The complaint

1. The complainant, who I will call Ms B, says the Council does not provide a sufficient personal budget to meet her son, Mr C’s, adult social care and support needs throughout the day and night. Ms B was supplementing it by supporting Mr C but can no longer do so. Ms B is worried she cannot afford to pay the support workers and Mr C’s care will suffer.

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The Ombudsman’s role and powers

2. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word ‘fault’ to refer to these. We cannot question whether an organisation’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), 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(i), as amended)

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How I considered this complaint

4. I considered:
• Information provided by Ms B and the Council.
• The Care Act 2014 and associated statutory guidance.
5. Ms B and the organisation 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

6. Mr C is an adult with cerebral palsy. Mr C lives independently since October 2020. The Council assessed Mr C needs 24-hour live in care to support him.
7. When a council assesses someone needs support, it gives them a personal budget. This is the amount needed to meet their care needs. The person can choose to receive their personal budget as direct payments, which means they can then choose how to spend that budget to meet their care and support needs.
8. The Council provides Mr C with direct payments; he employs personal assistants. Ms B was also providing care and support to Mr C until March 2021 when she became ill. Ms B has been unable to provide the same level of support since due to ongoing health complications. At the same time Ms B was in hospital, there was a breakdown in care as Mr C’s personal assistants were also ill.
9. The Council provided an emergency temporary care package using care workers from a care agency while Mr C was without his normal support.
10. Ms B told the Council Mr C’s personal budget was not enough to meet his care and support needs. Mr C was already spending his budget on his paid carers, so had no extra funds to cover the care support Ms B was no longer providing. The Council completed a review of Mr C’s care and support. The Council assessed Mr C still needed live in care and increased his budget by around £430.00 per week.
11. The Council says it had a meeting with Ms B and Mr C and explained the reason Mr C did not have enough funds in his direct payment account was because of the way Mr C was arranging his support. Mr C was paying a personal assistant an hourly rate rather than the standard rate for a live in service which is usually a weekly rate.
12. Mr C’s care and support plan specifies live in care, which is employing someone who lives with you and is usually paid weekly. This can be half the cost of paying an hourly rate for personal assistants to be with you 24 hours, which is what Mr C does. However, Mr C has choice and control about how to spend his budget, and with the help of Ms B he was meeting his needs by employing personal assistants rather than live in carers. Though even with Ms B’s unpaid support Mr C was often going over his budget.
13. The Council arranged a care provider who would employ Mr C’s existing personal assistants so that he remained with consistent support from those he knows and has built rapport with. The same care workers would then become live in carers and could meet Mr C’s support needs within his personal budget. Mr C turned down this offer.
14. Around nine months later Ms B contacted the Council to say Mr C’s personal assistants had left employment and she was trying to meet his needs. Mr C was struggling to recruit new personal assistants on the hourly wage available. Mr C agreed to a care agency to meet his needs, which the Council arranged. This support is currently ongoing, which Ms B hopes will be temporary and they can go back to having personal assistants.
15. The Council is currently reviewing Mr C’s care and support plan. At the current review the Council has asked about Mr C using incontinence products at night. This is not Mr C’s preference; he is continent but needs support to access the toilet or a urine bottle. Mr C has an overactive bladder so needs to pass urine frequently. Ms B says Mr C needs support through the night every one to two hours. Mr C’s 2021 care and support plan said Mr C needed support once or twice in the night. At that review Mr C’s care worker said they get up two or three times in the night to support Mr C. I do not know whether this frequency has increased, the Council should consider this at the review.

Was there fault causing injustice?

16. I must now consider whether there was fault by the Council which caused injustice to Ms B and Mr C. If so, I will consider what actions the Council can take to put things right.
17. The Council is required to assess Mr C’s care needs, provide a personal budget sufficient to meet those needs, and provide a care and support plan of how those needs will be met. The Council has done those things.
18. There is disagreement between Mr C and the Council about the personal budget, but I cannot say that is fault of the Council. The Council has provided the budget based on the relevant assessment and its knowledge of the local market. Therefore, there is no reason for me to question or criticise the Council’s decision even though Ms B and Mr C disagree with it. The reason the personal budget was not enough previously was because Mr C was using it to purchase a more expensive care product than that specified in his care and support plan.
19. Ms B has provided me with evidence of contact she has had from a live in care agency, Mr C’s personal budget is within the cost range quoted by that agency which demonstrates it is possible to purchase the needed care for within the personal budget. Ms B says the care agency later said they could not meet Mr C’s individual needs for his budget. If there was not a suitable agency within budget, then the Council would need to uplift the budget accordingly. But there is no evidence to say the indicative personal budget is fault.
20. I recognise Ms B and Mr C have found it difficult to recruit personal assistants and feel there is not enough money to pay what they need. However, this is not through fault of the Council. This is because of how Mr C has chosen to use his direct payments, and his preference of recruiting a personal assistant on an hourly wage rather than a live in carer as assessed.
21. The Council has ensured Mr C’s care needs have been met by providing additional money when there has been a shortfall and providing care support when existing support was unavailable.
22. The Council is currently reviewing Mr C’s care and support, which should consider overnight care support, and how best to meet Mr C’s needs in that regard. At this stage I cannot make any finding on that issue. Getting up two to three times a night is a normal expectation of a live in carer. If a higher frequency is needed, then an additional carer may be needed overnight to allow the live in carer to get adequate sleep.

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Final decision

23. I have completed my investigation on the basis there is no fault by the Council.

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Investigator's decision on behalf of the Ombudsman