Summary: The Council was at fault in how it considered what funds Mrs W should have to pay for her social care support. It was also at fault in how it reviewed Mrs W’s needs. The fault caused Mrs W’s representative, Miss X avoidable frustration and meant Mrs W went without support she should have had. The Council will apologise to Miss X, make symbolic payments and make service improvements to prevent fault in future.

The complaint

1. Miss X complained the Council delayed arranging for her elderly relative, Mrs W, to receive direct payments so Mrs W could commission her care and support directly. Miss X also said the Council’s administration of the direct payment process was poor.
2. Miss X said this impacted Mrs W’s wellbeing and caused them both upset.

Back to top

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 significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. When considering complaints we make findings based on the balance of probabilities. This means that we look at the available relevant evidence and decide what was more likely to have happened.
5. We investigate complaints about councils and certain other bodies. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, sections 24A(1)(A), and 25 (7) as amended)
6. 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)
7. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

Back to top

What I have and have not investigated

8. I am investigating the period between late November 2024, when Miss X asked the Council about direct payments, to April 2025, when the direct payments began.
9. The law says we cannot normally investigate a complaint unless we are satisfied the organisation knows about the complaint and has had an opportunity to investigate and reply. However, we may decide to investigate if we consider it would be unreasonable to notify the organisation of the complaint and give it an opportunity to investigate and reply. (Local Government Act 1974, section 26(5), section 34(B)6)
10. Since complaining to the Ombudsman, Miss X has said she is concerned the Council did not charge Mrs W correctly when she was receiving a Council-commissioned care package and that it has not responded to her requests for a copy of Mrs W’s care invoices. She also said she is unhappy the Council has not offered her a carer’s assessment. Miss X has not complained to the Council about these matters and it is reasonable for her to do so. As a result, I have not investigated them.

Back to top

How I considered this complaint

11. I considered evidence provided by Miss X and the Council as well as relevant law, policy and guidance.
12. Miss X and the Council have an opportunity to comment on my draft decision. I will consider any comments before making a final decision.

Back to top

What I found

Relevant law and guidance

Needs assessments and care and support plans

13. 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. The care and support statutory guidance sets out more information on what needs assessments must cover. The purpose is to identify if the person has any ‘eligible needs’. A person has eligible needs if:
• First- the person’s needs were the result of physical or mental impairment or illness;
• Second- those needs mean the person is unable to achieve two or more of 10 outcomes set out in the guidance. These are:
1. Managing and maintaining nutrition;
2. Maintaining personal hygiene;
3. Managing toilet needs;
4. Being appropriately clothed;
5. Being able to make use of the home safely;
6. Maintaining a habitable home environment;
7. Developing and maintaining family or other personal relationships;
8. Accessing and engaging in work, training, education or volunteering;
9. Making use of necessary facilities or services in the local community; and
10. Carrying out any caring responsibilities the adult has for a child.
• Third- not being able to achieve two or more of the outcomes is, or is likely to, significantly affect the person’s wellbeing.
14. If the person has eligible needs and has capital below £23,250 the council must meet those needs.
15. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan (or a support plan for a carer) following a needs assessment. 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. The support plan must include a personal budget.
16. 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.
17. 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)

Direct payments

18. 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.
19. Councils must tell people during the care planning stage which of their needs direct payments could meet. They should include information about direct payments, including how they are different to commissioned care, how they can be used and how the payments will be administered. Councils must consider requests for direct payments made at any time and have clear and quick procedures in place to respond to them.
20. 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. The council must provide interim arrangements to meet care and support needs to cover the period in question.
21. Councils must also make information about direct payments available to the public. This should include:
• What direct payments are;
• How to ask for them;
• What a direct payment agreement is, and how the council will monitor use of the payments;
• The responsibilities involved in managing the payments and employing people using them;
• Signposting to local organisations and council services which provide support to people with direct payments; and
• Case studies and evidence on how direct payments can be used. (Care and Support Statutory Guidance 2014)
22. The Council’s website has a section on direct payments. At the time of the events I am investigating, it did not include information on how a person could ask for direct payments. It only states that, if a person is given a personal budget during care planning, the Council will offer direct payments. The Council’s current website is also missing information on how people can ask for direct payments.
23. When a council agrees to give someone direct payments, it should issue a direct payment agreement, which is a contract between the person receiving the direct payments and their council. The agreement will typically set out how much money is available as a direct payment, what the person must contribute towards their care, and the terms and conditions of using the payments.

Care and support plan reviews

24. 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. 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.

Quality of care

25. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards that registered care providers must achieve. The Care Quality Commission (CQC) has guidance on how to meet the fundamental standards.
26. Regulation 16 says a persons care and treatment must be appropriate, meet their needs and reflect their preferences.

Council complaint procedure

27. Councils should have clear procedures to deal with social care complaints. Regulations and guidance say they should investigate and resolve complaints quickly and efficiently. A single stage procedure should be enough. The council should include in its complaint response:

• How it considered the complaint;
• The conclusions reached about the complaint, including any required remedy;
• Whether it is satisfied all necessary action has been or will be taken by the organisations involved; and
• Details of the complainant’s right to complain to the Local Government and Social Care Ombudsman. (Local Authority Social Services and National Health Service Complaints (England) Regulations 2009)

28. Council residents sometimes contact a councillor to raise concerns. If the councillor highlights those concerns to the council, the council normally treats it as a “members enquiry”. The council issues a response to the councillor, which they can pass onto the resident.

What happened

29. This section sets out the key events in this case and is not intended to be a detailed chronology.
30. Mrs W had a package of care at home, which she paid a contribution towards. The Council paid the care provider the rest of the amount due. The package was for four visits per day, as follows:
• Morning- one hour;
• Lunch- 30 minutes;
• Afternoon- 30 minutes; and
• Night- 45 minutes.
31. Each visit was attended by two care workers because the Council had decided this was necessary in order to move Mrs W safely. This is known as double-handed care. The care package amounted to 38.5 hours per week.
32. Miss X was unhappy with the care Mrs W was receiving, so in late November 2024, she asked the Council whether Mrs W could have direct payments. Miss X wanted the payments so she could hire personal assistants to take of Mrs W.
33. The following day, the Council reviewed Mrs W’s care and support plan. It noted:
• Mrs W needed help with personal care, including washing, moisturising her skin and dressing in appropriate clothes. She also needed help going to the toilet, managing any incontinence, preparing and eating meals, taking her medication and keeping her home clean and tidy;
• Mrs W had expressed a desire to go to church services. The Council advised Mrs W to consider going to a day centre;
• Mrs W still needed four visits per day, but the lunch and afternoon visits could be “singled-handed”, that is attended by a single care worker;
• Miss X had asked the Council to arrange for care workers to clean and do laundry for one additional hour per week.
34. In early December, the Council told Miss X it would take Mrs W’s case to a funding panel to decide if she should have direct payments. The Council referred Mrs W to an organisation it used which managed direct payments for people (provider A). If agreed, the Council would put the direct payment money into a virtual ‘wallet’ which provider A would then use to pay the personal assistants.
35. In mid-January 2025, Miss X told the Council she was unhappy with the care provider’s service, including that care workers were not doing Mrs W’s laundry.
36. Miss X asked for a review of Mrs W’s care needs a week later, in late January.
37. A few days later, Miss X spoke to the Council and asked whether the direct payments would be for double or single-handed care, because she felt Mrs W did not need double-handed care. The Council said Miss X could spend the payments how she wanted; on single-handed care if she wished. The Council confirmed Mrs W would have direct payments to fund 30 hours and 15 minutes of care per week. Miss X queried this as Mrs W’s current care package was for 40.5 hours per week. This was her previous care package plus two hours per week for care workers to do domestic tasks.
38. Just over a week later, the Council told Miss X it had agreed to fund 37.10 hours of care per week, double-handed.
39. Shortly after, Miss X asked the Council for information about how the direct payments would be administered.
40. Around that time, Miss X added that care workers were not showering Mrs W.
41. The Council visited Mrs W’s home to review her care again in mid-February. The review noted Miss X thought Mrs W only needed singled-handed care. However, she wanted the visits to last for longer to compensate, plus eight more hours for Mrs W to go to church and four more for her to go to a day club. This came to 51 hours per week. Miss X also said that instead of two hours housework per week, she wanted care workers to do 5 and half hours. This amounted to a total of 56.5 hours of care per week. The review records state the Council said it would consider Miss X’s request further.
42. Miss X says the Council worker who reviewed Mrs W agreed, at the meeting, that Mrs W could have 51 hours per week.
43. In late February, provider A contacted the Council to find out what hours it had agreed. The Council said it had agreed 52.5 hours of care per week.
44. Four days later, the Council told Miss X it had reviewed Mrs W’s care package and decided to fund 40.5 hours.
45. In early March, Miss X complained to the Council. She also sent her complaint to a councillor at the Council. The councillor passed the complaint to the Council’s adult social care service. Miss X said:
• The Council’s communication about how direct payments work and what package Mrs W would get had been poor;
• The Council had said it would take two weeks for Mrs W’s case to go to the funding panel in December, but it had delayed repeatedly;
• The Council had not reviewed Mrs W’s care plan;
• She was unhappy the Council had reduced Mrs W’s care package back to 40.5 hours per week;
• She felt Mrs W’s care package needed to include 30 minutes per day for showering;
• Mrs W was isolated because the Council had not allocated hours for her to go to church or a day centre; and
• Mrs W needed three more hours per week for domestic tasks including laundry. Ultimately, Miss X wanted the Council to agree the 56.5 hour per week care package she had asked for in the mid-February review.
46. A few days later, the Council told provider A it would fund the costs for 56 hours of care per week.
47. The direct payments were due to begin in mid-March, so the care provider stopped supporting Mrs W then. Miss X identified personal assistants who could support Mrs W, and they began carrying out visits. The visits were all single-handed.
48. The Council did not put the direct payment money into the virtual ‘wallet’ for some time after the direct payments should have begun. During that time, the personal assistants chased Miss X for payment and provider A highlighted to the Council that there was a risk the personal assistants would stop supporting Mrs W.
49. The Council treated the councillor’s contact as a members enquiry and responded to it that way. It said the care provider had responded to the points Miss X had made. The care provider said Mrs W had double-handed care. It set out its response to a concern Miss X had raised separately about how care workers had treated Mrs W when she had been incontinent. It said laundry was not part of Mrs W’s care package but care workers still helped with it twice a week, when they had time.
50. In July 2025, the Council issued a care and support plan for Mrs W which confirmed she needed single-handed care. The Council arranged for Mrs W to have equipment at home which allowed a single person to transfer her safety in and out of bed.
51. I asked the Council for copies of all care and support plans in force between November 2024 and April 2025, as well as all care plans the care provider drew up based on the Council’s care and support plans. The Council was unable to locate any. It said records indicate it sent Miss X a care and support plan in February 2025, but it does not have any other evidence this happened. Miss X has confirmed she did not receive any plans.

Findings

Information about direct payments

52. There is no evidence the Council gave Miss X the information set out in paragraph 19 when she first asked about direct payments for Mrs W. This was fault and meant she had to ask for that information herself, which caused her frustration.
53. The Council was also at fault for failing to make all the information about direct payments required by the care and support statutory guidance available to the public (as in paragraph 21). During the time I have investigated, its website was missing information on how a person can ask for direct payments and it continues to omit that information. This means residents are given the impression the only way to get direct payments is when the Council offers them during the care planning process. They are unaware that they can request the payments at any time.

Care plan reviews

54. The November 2024 care and support plan review resulted in the Council deciding to increase Miss X's care package by two hours and to remove the need for double-handed cared at the lunch and afternoon visits. However, the Council failed to amend and issue the new plan to reflect those changes. This was fault and caused Miss X frustration.
55. The Council implemented the increase in care package for domestic tasks but was at fault for failing to amend Mrs W’s care package so that she only received single-handed care at the lunch and afternoon visits. This caused Miss X frustration but did not cause Mrs W a significant personal injustice because her care needs were still being met.
56. In addition, at the November 2024 review, Mrs W expressed a desire to go to church. To comply with the Care Act 2014, councils must consider if a person’s needs mean they are unable to make use of necessary facilities or services in the local community. This includes going to church. If so, the council would have had to meet those needs, if the person had less than £23,250 in capital, as in Mrs W’s case. The Council failed to do this, which was fault. Instead, it advised her to consider going to a day centre. A day centre is not a church. On balance of probabilities and given the Council later agreed Mrs W should have support to go to church, had the Council not been at fault, it is likely it would have agreed that support from November 2024 onwards. This means Mrs W missed out on support she should have had.
57. After Miss X asked the Council to review Mrs W’s care in late January, the Council held a review without delay, in mid-February. However, despite the fact Miss X had said she thought double-handed care was unnecessary, the Council failed to consider if Mrs W still needed it at the review, and failed to explain its decision to Miss X. This was fault and caused her further frustration.
58. At the review, Miss X asked the Council to consider increasing Mrs W’s care package. The Council ultimately agreed that Mrs W needed 56 hours of care per week, which was the direct payment package it began paying for. The decision that Mrs W needed 56 hours of care per week should have been set out in an amended version of Mrs W’s care and support plan, so Miss X could see what support the hours were meant to cover, when they would be delivered, and why the Council did not agree to the full 56.5 hours Miss X felt were necessary. Although the Council’s records state it sent Miss X a care plan in February 2025, there is no record this actually happened and Miss X has confirmed she did not receive one. On balance of probabilities, the Council failed to issue an amended care and support plan following the February review. This was also fault and caused Miss X additional frustration.
59. It is positive that since the matters I have investigated, the Council has held a further review and issued a care and support plan for Mrs W. Miss X is happy with that plan and Mrs W’s care package.

Direct payments

60. When a person requests direct payments to commission their support directly, the council should consider the request based on the package set out in the person’s care and support plan, as that is how it has decided to meet the person’s eligible needs. The council should make the decision on whether to agree direct payments as quickly as possible.
61. Miss X asked the Council to approve and arrange direct payments for Mrs W in late November 2024 but it did not make its decision until March 2025. Overall, the Council took three months to consider Miss X’s request. This was too long and was fault. It caused Miss X avoidable frustration, particularly as it meant Mrs W had to continue being supported by a care provider which Miss X was unhappy with. The Council should have made its decision promptly, based on Mrs W’s care and support plan at that time. The Council could then have considered amending the direct payment amount when Miss X asked for a review of Mrs W’s needs and an increase in the size of her care package.
62. The Council’s consideration of whether to agree direct payments was complicated by the fact that, as set out above, it never had an up-to-date care and support plan which set out Mrs W’s needs and how many hours of care and support she needed each week. Instead, the Council made multiple decisions about how many hours Mrs W needed per week, some of which meant it decided to pay for fewer hours of support than Mrs W was receiving at that time. There is no evidence of how the Council decided this was appropriate or why it made so many different decisions between January and March 2025. In addition, because the Council’s decisions did not correlate to Mrs W’s care and support plan and because the Council did not otherwise explain the rationale for its decisions, Miss X could not understand how the Council had decided what hours Mrs W should have. This was fault and caused Miss X uncertainty and frustration.
63. It is also concerning that, in January 2025, the Council told Miss X that she could using direct payments to commission single-handed care. At that time, the Council had decided that Mrs W needed double-handed care, at least in the morning and nighttime visits, to keep her safe. If the Council was of that view, it would be a safeguarding concern if Miss X potentially failed to ensure Mrs W’s safety by commissioning single-handed care. The Council was at fault for giving Miss X permission to do that. It did not cause Mrs W an injustice because when Miss X did arrange for Mrs W to have single-handed care, she was not harmed. However, I am concerned similar advice could be harmful in other situations and so have made a recommendation to prevent such fault in future.
64. After agreeing the direct payments, the Council failed to send Miss X a direct payment agreement. This would have provided Miss X with confirmation of how much money Mrs W would receive, how much Mrs W would need to contribute to her care and the terms and conditions of using the money. Miss X still does not have a signed agreement with the Council. This was fault and caused her frustration.
65. The Council then delayed putting the funds into a virtual ‘wallet’. This meant Miss X was unable to pay the personal assistants supporting Mrs W for a time, which was fault. It caused Miss X distress as she was concerned the personal assistants would stop helping Mrs W without payment, but it did not cause Mrs W an injustice because ultimately, they did continue to visit her.
66. I have not recommended the Council take action to prevent delays putting funds into virtual wallets in future because the Council has confirmed it is now using a different system which is working better.

Quality of care

67. Miss X feels Mrs W should have frequent showers. The November 2024 and February 2025 reviews note that Mrs W needed help with personal care, but without a care and support plan, it is not clear how it had decided this should have happened day-to-day. Nonetheless, the care records show Mrs W was supported to wash every day, except one. The Council was at fault for the care provider’s failure to wash Mrs W on that day, which meant her needs were not met. This was not in line with regulation 16 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
68. The Council was not at fault for the rest of days the care provider supported Mrs W because it still met her need for support washing, albeit not in the way Miss X wished.
69. Miss X expected the care provider to help Mrs W with her laundry and was unhappy with how often it was doing that. The care provider confirmed laundry was not part of Mrs W’s care package but without a care and support plan, I cannot confirm if this was accurate. Mrs W’s November 2024 and February 2025 care and support plan reviews only noted she needed help maintaining a clean and tidy home.
70. Miss X told the Council she was unhappy care workers were not helping more with Mrs W’s laundry a week before she asked it to review Mrs W’s care and support needs in late January 2025. It was appropriate for the Council to consider Miss X’s concerns about the laundry as part of that review, which it did. The Council was not at fault.

Complaints handling

71. When Miss X complained to the Council and a councillor, it responded only to the councillor as a member’s enquiry. This was fault. The Council received a complaint from Miss X and it should have responded in accordance with the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009. In addition, the response was poor, which was further fault. It failed to respond to the points Miss X made and instead only passed her the care provider’s response to a matter that was not part of her complaint.

Back to top

Action

72. Within one month of the date of my final decision, the Council will take the following actions.
1. Apologise to Miss X for the frustration and uncertainty she felt as a result of the faults set out in this decision. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The Council will consider this guidance in making the apology.
2. Pay Miss X £250 to recognise the frustration and uncertainty she felt because of the faults set out in this decision.
3. Pay Mrs W £500 to recognise the impact of missing out on support to go to church, and the day care workers failed to wash her.
4. Issue Mrs W a direct payment agreement, if it has not done so since the events I have investigated.
5. Confirm if Mrs W has since received sufficient funds to pay the personal assistants for the care they delivered while there was no money in the wallet.
6. Add to the Council’s website information about how people can ask for direct payments, in line with the care and support statutory guidance, paragraph 12.7.
7. Clarify with complaints staff that if they receive a complaint from a resident and a member’s enquiry from a councillor about the same matter, they must still respond to the complaint using the appropriate complaints procedure.
73. Within three months of the date of my final decision, the Council will review this complaint and identify why the Council failed to issue amended care and support plans after the November 2024 and February 2025 reviews, and why the Council failed to implement the change to single-handed care for Mrs W at lunchtime and afternoon visits after the November 2024 review. The Council will consider what steps it needs to take to prevent similar fault in future, and tell the Ombudsman what those steps are and when it will complete them by.
74. The Council will provide us with evidence it has complied with the above actions.

Back to top

Decision

75. I find fault causing injustice. The Council has agreed actions to remedy that injustice.

Back to top

Investigator's decision on behalf of the Ombudsman