Summary: Mr X complains that the Council took too long to assess his needs, failed to make adaptations to his property that an Occupational Therapist recommended, and handled his complaint poorly. He has been unable to properly wash himself for over two years. He says he is distressed, anxious, and disgusted with the Council. The Ombudsman finds fault with the Council which has caused injustice to Mr X. The Council has agreed to apologise to Mr X, make a payment to recognise the failure to meet his care needs and how that has affected him, and take action to address the faults with its service provision. The Council has also agreed to inform all local authority tenants with disabilities who are waiting for adaptations to their homes of their right to apply for funding.

The complaint

1. The complainant, who I refer to here as Mr X, complains about the way the Council has handled making adaptations to his home. He says the Council:
1. took too long to complete an Occupational Therapy assessment;
2. delayed implementing recommendations made by the Occupational Therapist in February 2017;
3. has not implemented recommendations made by the Occupational Therapist in February 2018; and,
4. has handled his complaint poorly.
2. Mr X says he urgently needs a walk-in shower (known as a ‘level access shower’). He says he has not had a bath or shower in a very long time because of the danger of falling in the bathroom. He says he is distressed and anxious, and disgusted with the Council.
3. Mr X says he has waited a long time for adaptations which have not been done.

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What I have investigated

4. The Ombudsman cannot investigate complaints that are more than 12 months after the complainant first had knowledge of the problem, unless there are good reasons to do so (see paragraph ten).
5. In this case, Mr X complained to the Ombudsman in October 2018. It appears that Mr X first became aware of a problem when he repeatedly called the Council between May and July 2017 and did not get a reply. He formally complained to the Council in April 2018. To date, the Council has not completely resolved the problem, and Mr X is still in the same position he was in in October 2016.
6. Overall, I consider that the injustice to Mr X is ongoing. For this reason, I have decided to there are good reasons to investigate this complaint.

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The Ombudsman’s role and powers

7. 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)
8. 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)
9. The Local Government Act 1974 sets out our powers but also imposes restrictions on what we can investigate.
10. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. (Local Government Act 1974, sections 26B and 34D, as amended)

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How I considered this complaint

11. I considered the information and documents provided by Mr X and the Council. I spoke to Mr X about his complaint. Mr X and the Council had an opportunity to comment on an earlier draft of this statement. I considered all comments before I reached a final decision.
12. I have considered the relevant legislation, statutory guidance and policies, set out below.
13. The Council has decided that the adaptations to Mr X’s home will be funded from a ‘major works’ budget, rather than through a Disabled Facilities Grant (DFG). However, in terms of good practice, I have referred to guidance on DFGs. This is because the principles of how to deliver adaptations should equally apply to other possible ways of completing home adaptations for people with disabilities.

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What I found

14. 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. The assessment must be of the adult’s needs, how they impact on their wellbeing, and the results they want to achieve.
15. The Care and Support Statutory Guidance (regularly updated) says “while there is no defined timescale for the completion of the care and support planning process, the plan should be completed in a timely fashion, proportionate to the needs to be met” (section 10.84). It says, “the planning process should not unduly delay needs being met”.
16. The Care Act 2014 says that local authorities must meet an adult’s care and support needs if they meet certain eligibility criteria. The Act says that it is a local authority’s duty to promote an individual’s wellbeing. ‘Wellbeing’ includes personal dignity, a person’s control over their everyday life, and suitability of their living accommodation.
17. The Care Act 2014 recognises that suitable accommodation is one way of meeting care and support needs. Prevention is critical to the Care Act, and home adaptations are an example of secondary prevention.
18. The government issued guidance to help local authorities: ‘Delivering Care and Support Planning: supporting the implementation of the Care Act 2014’. This says:

“Councils need to think about the continuity between assessment of need, the identification of outcomes and resource allocation. Assessments … must lead to outcome statements and resources should be allocated on the basis of these outcomes.”

Disabled Facilities Grants

19. Local authorities have a statutory duty to provide help for major adaptations to the homes of people with disabilities. This is usually done through a Disabled Facilities Grant (DFG). Owner-occupiers, local authority tenants and private tenants, among others, can apply to the local authority for a DFG to make their home more accessible.
20. DFGs must be used to meet the cost of adapting a property to meet specific needs, for example providing ramps, installing a stair lift, or adapting/providing accessible washing facilities.
21. The law says housing authorities shall consult with social services authorities to decide whether proposed works are ‘necessary and appropriate’. Housing authorities can, but do not need to, use an occupational therapist employed by a social services authority to assess need.
22. Article 3 of the Regulatory Reform (Housing Assistance) (England and Wales) Order 2002 enables housing authorities to give discretionary assistance in any form (including grant, loan or equity release) for adaptations.
23. In February 2015, the government adopted the ‘Home adaptations for disabled people: a detailed guide to related legislation, guidance and good practice’ published by the Homes Adaptations Consortium in 2013.
24. This non-statutory guidance says:

“The purpose of an adaptation is to modify the home environment in order to restore or enable independent living, privacy, confidence and dignity for individuals and their families. The focus is therefore on identifying and implementing an individualised solution to enable a person living within a disabling home environment to use their home more effectively rather than on the physical adaptation itself.”

25. The guidance says: “Local priority systems should not be used to manage demand and create waiting times beyond the statutory timescales”. It also says potential service users should not be disadvantaged because of the time of year they first ask about the service. The guidance recognises that local authorities are likely to have spent their DFG budget towards the end of a financial year, but says they “should not refuse or defer a service”.

Complaints procedure

26. Councils should have clear procedures for dealing with social care complaints. Regulations and guidance say councils should investigate a complaint in a way which will resolve it speedily and efficiently. A single stage procedure should be enough. A council should say in its response to the complaint:

• how it has considered the complaint;
• what conclusions it has reached about the complaint, including any matters which may need remedial action;
• whether the responsible body is satisfied it has taken or will take necessary action; 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)

27. The Council says its adult social care complaints procedure is in line with the Regulations.

What happened

28. Mr X is retired and lives alone. He has physical health and mobility problems which are deteriorating.
29. In October 2016, Mr X’s neighbour called the Council’s social care access team, requesting assistance for Mr X because he was having difficulty with his personal care. The neighbour told the Council that Mr X had had two recent falls and that he could not get in the bath.
30. A few days later, Mr X spoke to the Council’s access team who did a ‘screening assessment’ over the phone. Mr X told the Council he was unable to use the bath and that he was having difficulties walking. He told the Council about his medical conditions and medical history, including his recent history of falls.
31. The Council told Mr X it would send him a catalogue so he could look at equipment he could buy that could help him. It advised him to seek assistance from his GP about his recent falls, and to request a referral to see a physiotherapist.
32. At the end of 2016, Mr X was admitted to hospital. He was discharged at the end of January 2017.
33. In mid-January 2017, the Council allocated Mr X an Occupational Therapist because of his difficulties accessing his bath.
34. The Occupational Therapist met Mr X in early February. Mr X asked for an over-bath shower. The Occupational Therapist said this would promote Mr X’s independence and safety.
35. The Occupational Therapist noted that Mr X had to wash himself at the bathroom basin. She noted Mr X preferred not to have formal care provided in home. One of her recommendations was that she would discuss getting Mr X an over-bath shower with the access team’s manager.
36. The Occupational Therapist completed an eligibility decision form under the Care Act 2014. On this form, she said Mr X’s needs arose as a result of, or were related to, a physical impairment or illness. She said Mr X was not able to manage his personal hygiene. She said this had a significant impact on his physical and mental wellbeing, control over day-to-day life, and the suitability of living accommodation. This meant Mr X was assessed as eligible to have his care needs met.
37. In March, Mr X spoke to the Council. He said he had received a perching stool for the kitchen, which he found helpful. He asked why he had not been provided with a perching stool for the bathroom. The Occupational Therapist said she had agreed with Mr X at his initial assessment that the Council would provide a stool for the bathroom, but not before the bathroom door had been rehung to open outwards, because of the limited space in the bathroom.
38. The Occupational Therapist told Mr X that because the door had not been rehung, he had not been given the perching stool for the bathroom.
39. Between May and July, Mr X called the Council five times asking for an update. Each time, the Council told Mr X that the Occupational Therapist was not there but she would call him on her return.
40. Council records show that on the date of Mr X’s fifth call to the Council (mid-July), the housing adaptation manager said she had not received a request for adaptations to Mr X’s house.
41. A few days later, the Council called Mr X. It said the Occupational Therapist would be told to call him.
42. Over a week later, Mr X called the Council again. He said he was still waiting for works to be done (equipment provided and rails installed). He said he was still struggling. He also said he had made countless calls to the Council which no one returned. The Council said someone would call him back that day.
43. Later that day, the Occupational Therapist called Mr X. She apologised for not getting back to him, and said she would review his case.
44. The Occupational Therapist visited Mr X at home in early August. She reviewed Mr X’s needs. Mr X said he had been using the perching stool in the kitchen, where he had to wash himself at the kitchen sink. He said again that he was not able to use bathroom.
45. Mr X agreed with the Occupational Therapist that a level access shower would better meet his needs, rather than an over-bath shower.
46. In September, the Occupational Therapist left the Council.
47. In November, the Council allocated Mr X a new Occupational Therapist. He visited Mr X at home.
48. Three days after this meeting, the new/second Occupational Therapist requested the stair rail that the first Occupational Therapist had recommended. This was for the communal area outside Mr X’s home so that he could access his home safely.
49. Also on this day, Mr X’s case was transferred to the care management team for the level access shower and other works to be progressed.
50. At the end of November, the second Occupational Therapist completed an assessment for Mr X. The reason for this assessment was “to continue the assessment for provision of bathroom adaptation”.
51. The Occupational Therapist noted that Mr X could not get into the bath, did not have an over-bath shower, and was unable to bathe. He recommended “exploration of major adaptations in the bathroom to reduce/prevent/delay future needs around personal care”. This is how the Occupational Therapist said Mr X’s needs would be met.
52. Specifically, the Occupational Therapist recommended rehanging the bathroom door, installing a level access shower, and replacing the bathroom basin.
53. In January 2018, Mr X called the Council for an update. He left a message for the Occupational Therapist.
54. In February, Mr X called the Council again, because no one called him back. The Occupational Therapist called him back the same day. He told Mr X that the recommendation for a level access shower had been approved.
55. In April, Mr X complained to the Council. He complained that the Council was not fulfilling its legal duties to implement recommendations made by the first Occupational Therapist in February 2017, and also by the second Occupational Therapist in February 2018.
56. In early June, the Council fitted the stair rails to the communal area that had been recommended by the first Occupational Therapist in February 2017.
57. In mid-June, the Council sent Mr X its response to his complaint. It said the housing department was “unable to locate a record” of the Occupational Therapist’s recommendations from February 2017. It said the housing department had since liaised with social services, and had got a copy of the recommendation.
58. The Council said it had recently fitted stair rails. It apologised for the delay.
59. The Council confirmed that the second Occupational Therapist’s recommendations were to create level access shower facilities, rehang the bathroom door and replace the basin. It said, “these works are currently going through the process and should be on site by August 2017”. (The Council has since said it meant 2018, not 2017.)
60. The Council said this response marked the end of the Council’s complaints procedure.
61. A week later, the Council completed a needs assessment for Mr X. It noted that he had been unable to access a bath for “quite a while”. It also said that the major adaptations would start in August 2018.
62. At the end of June, the Council put in place a care package for Mr X. Carers visited Mr X twice a week to wash his feet and legs to help with his physical health conditions.
63. In August, the Council reviewed this care package. This said that there had been a “noticeable improvement” for Mr X.
64. At this time, the Council completed a care and support plan. This said that Mr X needed carers to wash his legs and feet. It also said the Council was looking at providing major adaptations to Mr X’s home to meet his needs.
65. At the end of August, Mr X called the Council. He said he did not want carers, and that he can manage without them.
66. In September, Mr X spoke to the Council. The Council says it explained to Mr X “that the budget was fully committed this financial year and that the works due at his address would not be completed within this financial year”. The Council said it had been “instructed by senior management to proceed with priority 1 works only”, and that the Occupational Therapists’ recommendations did not fall into that category.
67. Mr X then asked for his complaint to be escalated in order to get the recommendations implemented.
68. The Council wrote to Mr X in October 2018. It said it had consulted with relevant teams within the Council but could add nothing more to its previous response.
69. Mr X then complained to the Ombudsman.

Analysis

Time taken to complete the Occupational Therapy assessment

70. Mr X complains that the Council took too long to complete an Occupational Therapy assessment (part a of the complaint).
71. The Council first became aware of Mr X’s needs in October 2016. The Council spoke to him within two days of this. The Council did a ‘screening assessment’. Mr X told the Council he was unable to use a bath and had difficulties walking.
72. In February 2017, the first Occupational Therapist completed an assessment, an eligibility decision under the Care Act 2014, and an interim care and support plan.
73. The guidance makes it clear that while there is no defined timescale to complete care and support plans, “the plan should be completed in a timely fashion, proportionate to the needs to be met”.
74. The Council accepts that there were 17 weeks between becoming aware of Mr X’s needs and completing the interim care and support plan.
75. I find that the Council failed to complete the care and support plan in a “timely fashion”, which is fault. This fault caused Mr X injustice because the Council could have identified Mr X’s eligibility and care needs earlier. This has contributed to the delay in meeting Mr X’s needs.

Delay implementing the first Occupational Therapist’s recommendations

76. Mr X complains that the Council delayed implementing recommendations made by the first Occupational Therapist in February 2017 (part b of the complaint).
77. In February 2017, the first Occupational Therapist recommended a stair rail (to the communal stairs) and a perching stool. She also recommended a discussion with the Access Team manager about installing an over-bath shower and rehanging Mr X’s bathroom door.
78. Mr X received the perching stool in March 2017.
79. The stair rail was not requested until November 2017. It was fitted in June 2018, 16 months after the Occupational Therapist recommended it.
80. This delay is fault. This fault caused Mr X, a vulnerable person with a history of recent falls, injustice because he was without a stair rail, and therefore at increased risk of falls on the stairs he used to access his home, for 16 months.
81. The Council says this delay was because the recommendation from social services to the adaptations team “could not be located”. The Council says it cannot be sure why the housing department could not find a record of the Occupational Therapist’s recommendation.
82. This poor record keeping is fault, and this fault contributed to the injustice caused to Mr X.
83. The over-bath shower was never installed. In November 2017, the second Occupational Therapist decided with Mr X that an over-bath shower would not meet his needs, so instead recommended a level access shower to meet Mr X’s needs.
84. I find fault with the Council for failing to act on the recommendation for an over-bath shower between the time it was recommended (February 2017) and the time a more suitable recommendation was made (November 2017).
85. The Council’s inaction left Mr X without appropriate washing facilities for that time: this is injustice. The Council failed to meet Mr X’s personal hygiene care and support needs.
86. The Council accepts that the first Occupational Therapist did not progress Mr X’s case or the agreed works. It accepts that the case was “not properly dealt with”.
87. The Council says, “there is no reason other than poor service/practice” to explain the delay between the recommendation and the case being transferred to the team that deals with adaptations and works.
88. It is positive that the Council recognises this fault. However, the fact remains that the only recommendation that was actioned in a timely fashion was providing Mr X with a perching stool.
89. The bathroom door has not yet been rehung. Below, I will further address the fault and injustice to Mr X caused by the failure to rehang the door (in part c of the complaint).
90. Mr X made six calls to the Council between May and July 2017, asking for an update. Each time, the Council told him that the Occupational Therapist would call him back. A person should not have to wait over two months and make six calls to get an update.
91. I find this is fault. The Council promised Mr X a service that it repeatedly failed to deliver. This caused Mr X injustice because of the time and trouble spent chasing the Council.

Failure to implement the second Occupational Therapist’s recommendations

92. Mr X complains that the Council has not implemented recommendations made by the second Occupational Therapist in February 2018 (part c of the complaint).
93. In November 2017, the second Occupational Therapist reviewed Mr X’s needs assessment. He made specific recommendations for adaptations. He proposed rehanging the bathroom door, installing a level access shower, and replacing the bathroom basin. This was authorised in January 2018.
94. In February 2018, the Occupational Therapist repeated his recommendations. He said the works were progressing and would be on site in August 2018.
95. The Council accepts that these works have still not been done.
96. The Council spoke to Mr X in September 2018 and told him the works would not be done in the 2018/19 financial year because of the Council’s budget restrictions. The Council says this is still the case.
97. The Council says, “outstanding works will be reviewed in April 2019 when budgets are replenished”.
98. In line with guidance, the Ombudsman would normally expect adaptations to be completed within six months.
99. Mr X wants to be able to wash himself without the aid of carers (who only washed his legs and feet). Mr X’s care and support plan and the Occupational Therapists’ assessments say that he will be able achieve this outcome once the adaptations are made.
100. The guidance says that a local authority can consider how to balance its finances and budgetary position with the duty to meet a person’s eligible needs “but not whether those needs are met” (section 10.27). It is my view that the Council’s decision (not to carry out these necessary works) is not in line with the guidance.
101. The Council has known since October 2016 that Mr X has not been able to use his bath, and has to wash himself at a sink or basin. The Council has clearly identified that Mr X has eligible care and support needs. It is my view that the Council has failed in its duty to meet this need. This is not in line with the Care Act’s principle of promoting wellbeing and independent living.
102. This is fault. This fault has caused Mr X ongoing significant injustice, and caused an avoidable loss of dignity.

Disabled Facilities Grants

103. As I have outlined above, local authorities have a statutory duty to provide help for major adaptations to homes of people with disabilities. This is usually done through a Disabled Facilities Grant (DFG).
104. The Council recognises that the legislation allows tenants of local authority properties to apply for a DFG. However, the Council says, “local authority tenants cannot use their Disabled Facilities Grant allocation to fund adaptations to local authority properties”.
105. The legislation says a DFG application “must” be approved where a person has applied for a DFG to facilitate access to a shower or bath. The legislation does not say that local authority tenants cannot use a DFG to make adaptations to local authority properties. However, councils can use different resources to fund these adaptations.
106. The good practice guide says, “tenants of local authorities … are eligible for DFG”. It also says, “the purpose of an adaptation is to modify the home environment”.
107. The Council’s website says that council tenants can apply for DFGs if they have problems with everyday tasks including bathing. The website also says DFGs can be used for “putting in a … level access shower”.
108. It is hard to understand how the Council expects a tenant who is granted a DFG to use that grant to fund adaptations to improve bathing facilities if they cannot adapt their homes.
109. The Council says council tenants cannot use DFGs to make adaptations to local authority properties. Instead, adaptations to council properties are made using different resources. The Council did not tell Mr X about his right to apply for a DFG, or other funding. However, I cannot say that if it had told him, that the works would have been completed by now. For this reason, I cannot say that this caused Mr X injustice.
110. The Council’s failure to tell Mr X of his right to apply for funding raises questions about whether it has told other local authority tenants about their right to apply for funding for adaptations.

Complaint handing

111. Mr X complains the Council has handled his complaint poorly (part d of the complaint). He says the Council has “just shrugged its shoulders”, and has failed to address the root of his complaint, which is that he wants to be allowed to wash himself properly.
112. I have dealt with the Council’s failure to meet Mr X’s needs above.
113. In its response to Mr X’s complaint in June 2018, the Council told him that the works “should be on site in August” (2018). The Council has failed to do that.
114. I find the Council is at fault for telling Mr X the work would be done when there is no evidence that the works were planned with an actual due date of August 2018.
115. Further, there is evidence that the Council did not intend to carry out the adaptations until after March 2019.
116. Telling Mr X that works would be done within two months then not doing the works is misleading, and is fault. This fault caused Mr X injustice because the Council gave him unrealistic expectations of when the works would be done, which led to further disappointment and frustration.
117. The Council says that its adult social care complaints procedure is in line with the the Regulations that govern adult social care complaints.
118. The Regulations say that a local authority must acknowledge a complaint within three days. I have seen no evidence that the Council did this.
119. The Regulations also say that a local authority must offer to discuss the complaint with the complainant, and discuss the ‘response period’ within which the investigation is likely to be completed. I have seen no evidence that this happened.
120. I find fault with the Council for not complying with the Regulations.
121. In October 2018, the Council responded to Mr X’s request to escalate his complaint. It said it had consulted with relevant teams within the Council but had nothing further to add to its previous response.
122. I find that this is a poor complaint response. The Council’s first response said works would be on site in August 2018. The Council’s second response did not comment on the fact that works had not been carried out two months earlier. It did not explain why the works had not happened, or when Mr X could expect the works to begin. It also appears dismissive of Mr X’s complaint. I find this is fault.
123. I find that this fault caused Mr X injustice because he was entitled to have his complaint fully investigated at the second stage, and there is no evidence that this happened.

Agreed action

124. Where there has been an unreasonable delay in a person receiving adaptations that would have improved their daily life, the Ombudsman recommends a payment that depends on the impact of the delay on the complainant.
125. I have taken account of factors such as the extent of the adaptations needed, the adequacy of current arrangements, and Mr X’s vulnerability. I have looked at similar Ombudsman decisions and calculated an average payment of approximately £124 per month for delays of this nature and this impact.
126. Within four weeks of this decision, the Council has agreed to make a payment to Mr X of £3620 to recognise the injustice cause by the faults. This is made up of:
• £3100 for failing to meet his care needs (by installing a level access shower) for 25 months;
• £320 for failing to install a stair rail for 16 months, leaving him at risk of further falls;
• £100 to reflect Mr X’s time and trouble in calling the Council six times and waiting over two months for a promised call-back; and,
• £100 for misleading Mr X as to when the works would be completed, leading to frustration and disappointment.
127. The Council says the works are due to begin on 7 May 2019, a date which Mr X agreed to. The Council has agreed to make a payment of £124 per month to Mr X for each month that the necessary bathroom adaptations are not completed, starting from 7 June 2019. This allows the Council one month to complete the works.
128. Within four weeks of this decision, the Council has agreed to write to Mr X and apologise for the following:
• The 17-week delay in assessing his needs, which contributed to the delay in meeting those needs;
• Failing to install an over-bath shower, and therefore not meeting his personal hygiene care needs;
• Poor record keeping;
• Failing to call Mr X back as promised with an update, meaning he had to wait two months for an update and call the Council six times;
• Failing to meet his care needs by not installing a level access shower, meaning he has suffered an avoidable loss of dignity;
• Failing to meet his care needs because of budgetary constraints;
• Misleading Mr X as to when the works would be completed, leading to frustration and disappointment; and,
• Failing to properly investigate his complaint.
129. I note that the Council apologised to Mr X in its first complaint response for failing to install a stair rail. I consider this a satisfactory apology.
130. Within four weeks of this decision, the Council has agreed to take the following wider action:
• To review this complaint and the Ombudsman’s findings with senior management to make sure that the lessons are learnt that identified care needs must be met, and budgetary restraints are not an acceptable reason for failing to meet care needs;
• To remind relevant staff that it is unacceptable not to investigate a complaint and provide a thorough response that addresses the complaint; and,
• To review all cases of local authority tenants with disabilities who are waiting for adaptations to their homes. The Council should inform each person of their right to apply for a Disabled Facilities Grant or other funding to make adaptations to their homes.
131. Regarding the last bullet point above, the Council says it has already reviewed all of its cases. It says it will write to its tenants and inform them of their right to apply for funding for adaptations.
132. The Ombudsman will need to see evidence that these agreed actions have been completed.

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Final decision

133. I have completed my investigation and uphold Mr X’s complaint in full. This is because there is evidence of fault in the Council’s actions which caused Mr X injustice. The Council has agreed to take action to remedy the injustice.

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Investigator's decision on behalf of the Ombudsman