Summary: Ms C complained the Council failed to install the adaptations she needed in a timely manner. As a result, Ms C said this put her at risk, which caused her distress. We found fault with the way time it took to progress Ms C’s case. The Council has agreed to apologise and pay a financial remedy for the distress Ms C experienced. It will also review its policy, the system and the resources it has in place for ensuring necessary adaptations are delivered in a timely manner.

The complaint

1. The complainant, whom I shall call Ms C, complains that even though the Council assessed in June 2019 that she needed adaptations to her property, it had still failed to install these as of August 2020, more than a year later. The adaptations included:
• An Intercom system, which she needed before the date of her operation on 8 January 2020.
• Mixed lever taps.
• A shower chair with arms and legs.
• Pull-out drop-down kitchen cupboard inserts, and a
• Raised toilet.

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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 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

4. I considered the information I received from Ms C and the Council. I shared a copy of my draft decision with Ms C and the Council and considered any comments I received, before I made my final decision.

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What I found

Relevant legislation and guidance

5. The council has a duty under the Care Act 2014 to meet the assessed eligible needs of a disabled adult. When it decides a disabled person needs home adaptations, the Ombudsman does not consider this duty ends until the needs are met.
6. The non-statutory guidance “Home adaptations for disabled people: a detailed guide to related legislation, guidance and good practice” identifies three key stages in the home adaptations process. Stage One starts with the initial enquiry at the first point of contact to the date when the OT sends a recommendation to the adaptation service (the landlord or grant provider). Stage Two runs from the OT’s recommendation to the approval of the scheme. Stage Three is from approval of the scheme to the completion of adaptation works.
7. The guidance gives target timescales for dealing with cases at each of the three stages. It defines an urgent case as a situation where a disabled person cannot be discharged from hospital or cannot access essential facilities within the home. A case is defined as non-urgent if the person cannot use the home fully but can access the toilet and bathing facilities. The guidance recommends the total time to complete all three stages should be no more than 55 working days (more or less 2.5 months) and 150 working days for non-urgent cases (about seven months).
8. The guidance also says that councils should clearly explain to clients what system it uses to prioritise cases as non-urgent or urgent, and what service standards it has about time targets etc.
9. Instead of having time targets for non-urgent and urgent cases, the Council only has time targets for ‘standard cases’, which are:
• 6 weeks after a request / application for adaptations has been received, the client should have been assessed and a detailed design and drawings should be approved.
• Within a further five weeks after that, quotes should have been obtained and the proposal should have been considered for approval.

What happened

10. Ms C lives in a first floor flat that belongs to a Housing Association. She was going to have an operation in early January 2020. Ms C is blind and would be unable to walk following the operation. As such, Ms C said it was very important to ensure the intercom would be in place before her operation on 8 January 2020. After this date, she would only be able to let people into her property and receive food and other deliveries via an intercom. Ms C said:
• The Council was aware of this risk but did not install the intercom by 8 January 2020.
• It only installed the intercom mid-February 2020. However, according to Government Guidance, it should have completed this within 55 working days, which is less than three months and not 8 months.
• If her operation had not been postponed twice, this delay could have resulted in a serious risk to her.
11. Ms C says the assessment in August 2019 also concluded she needed mixed lever taps, a shower chair, pull-out drop-down kitchen cupboard, and a raised toilet.
12. The Council told me that, when the Occupational Therapist (OT) completed the assessment in August 2019 they assessed this as “Category 2: STANDARD Client meets eligibility criteria, works to be progressed in chronological order.”
13. It also told me the Adaptations team target for completing non-urgent works is within 12 months from the application being received. However, I found the Service Level Agreement which the service uses says that it should be 15 to 16 weeks.
14. In mid-August 2019, the Council asked Ms C’s Housing Association for permission to do the adaptations, which it received three weeks later.
15. Ms C asked the Council at the end of September 2019 for an update and to be kept informed. The Council told Ms C that it was still obtaining quotes for works. Once this was completed, it would proceed.
16. The Council asked its contractor on 30 September 2019 to provide a plan for Ms C’s bathroom, which it received mid-October 2019.
17. On 25 October 2019, the Council changed the priority of the work to “Urgent: Client in imminent danger or unable to remain in home”. This meant that, according to government guidance, it would have to be carried out within 55 working days (less than three months). The Council told me that the change in priority was based on a discussion between the OT and a duty Occupational Therapist Prescribing Supervisor. It said the OT went through her clinical reasoning and was given authorisation to raise the category to urgent. However, there is no record of this discussion. As such, it is not clear why the case had not been urgent from the start or why it changed to urgent on this day.
18. It took three months, since getting permission from the Housing Association, to receive a quote on 22 November 2019 for installing the automated door entry.
19. Ms C informed the Adaptations team on 17 December 2019 that she had an operation planned for 8 January 2020. Although the Council tried to fast track this aspect of the adaptations, it took until 18 February 2020 before the work was completed. The work was completed before the actual operation happened because the operation was postponed twice. The Council did suggest to instal a key safe as a temporary alternative. However, Ms C turned down the suggestion because she did not feel that would be safe for her.
20. When Ms C made a complaint about the delays of this, and her other, adaptations, the Council told her in early March 2020 that it would provide the other adaptations in November 2020.
21. The Council told Ms C in mid-March and again in mid-April 2020 that it was still waiting for the formal financial approval for the remainder of the works. Part of this involved obtaining quotes for the work first. The Council told me that, by that time, progress was also starting to be delayed due to the Covid-19 pandemic and the need to make changes to the approval process. In addition to this, there was a backlog of cases including ones that were older than Ms C’s.
22. It took until 5 August 2020 until the formal financial approval was submitted, and 1 September until the grant was approved.
23. However, there was no further progress as Ms C advised the Council on 6 August 2020 that, following discussions with an OT, she would relocate to a more suitable property instead. The OT recommended this because Ms C’s flat was on the first floor and even installing a stair lift would not sufficiently reduce risk to her.
24. I asked the Council for the average time it took to complete adaptations standard / urgent adaptation cases. The Council said: 232 working days. The Council said it was unable to say what the average waiting time for urgent and non-urgent cases was.
25. Ms C says that she suffered an injustice due to the Council’s failure to install her adaptations (within a reasonable timeframe). She said that, in addition to the frustration of having to wait and chase the Council, and the distress this caused, she was also put at risk and inconvenience during this time:
26. Shower chair:
• Ms C says her old shower chair, which was fixed to the wall, was falling to bits and she had fallen over in the shower because it was inappropriate.
• The Council says the OT observed in August 2019 that Ms C could safely transfer off the shower chair. The OT also inspected the chair and concluded that, while it was stiff and did not fold away easily, there were no signs it was unsafe.
• Ms C says her old chair eventually fell of the wall in March 2020. As such, she had to ask a builder to put some sealant on it. However, her builder said this was a quick fix and not a sustainable solution. She says she reported this to the Council’s Adaptations Team, but they did not respond. However, the Council has told me there is no evidence she or her advocate raised this with the Council. It said if Ms C had said she was at (imminent) risk the Council would have immediately looked into this.
27. Pull-out drop-down kitchen cupboard inserts:
• Ms C says she has to use a step ladder to get into her cupboards due to their height. She says this is dangerous because she is blind, has a bad back and arthritis in her foot. As such, the Council has continued to put her at risk of injury.
• In response, the Council said that during the OT Assessment in 2019, the OT observed that, due to her sight impairment, Ms C had difficulty seeing what was in her kitchen cupboards. As such, the OT recommended that a pull-down and pull-out insert be installed in both upper and lower cupboards in the kitchen. It was only in August 2020, that Ms C said she was ‘climbing’ to use the kitchen cupboard. However, Ms C then asked the Council to put the works on hold, because she asked for an OT re-assessment as she felt the pull-out inserts would not help.
28. Raised toilet with handrails:
• Ms C says the Council has put her at continued risk of falling and injuring herself by not providing this. She says she has had a near miss falling off the toilet due to it not being raised or having a handrail.
• In response, the Council says the OT did not observe this to be a risk at the time of assessment and Ms C has not highlighted this to either the OT or the Adaptations team.
29. Mixed lever taps:
• Ms C says the mixed lever taps in the bedroom and the bathroom should also have been installed urgently. She says that in the absence of the mixed lever taps, she was put at risk because the water out of the hot tap is very hot and she has had to test the temperature of the hot water blindly by putting her hand in it.
• In response, the Council says that Ms C did not highlight this issue with the OT or Adaptations team at any time. As Ms C did not highlight this issue at any time, there was no urgency needed.
• However, this is not correct because the OT assessment report from August 2019 said that: Ms C reports that she has burnt herself trying to figure out which tap is hot or cold.
30. The remaining adaptations did not go ahead at the end of August 2020, because Ms C said she go through the process of finding and moving into a more suitable housing association property. I therefore asked the Council if an OT had subsequently visited Ms C to determine how any remaining needs / risks, related to the adaptations not being in place, would be met and managed in the interim. The Council acknowledged that it had not done this but would do this immediately.

Analysis

31. The Council has failed to have a clear system in place for prioritising cases. It has also failed to have clear and separate time targets in place for urgent and non-urgent cases. This is fault and not in line with relevant guidance.
32. The Council has also failed to differentiate between non-urgent and urgent cases, in terms of measuring how long adaptations actually take. This hinders its ability to effectively monitor its performance in this area.
33. The Council has also failed to provide clear information to its clients about the system it uses to prioritise cases as non-urgent or urgent, and what service standards it has about time targets etc. It has only one set of time targets, rather than one for non-urgent and one for urgent cases. This is fault and not in line with relevant guidance. Although the Council has provided some general information about DFGs on its website, this does not include this information.
34. Once the Council has made a decision about the urgency of a case, it should explain to its clients (with reference to its system) how it arrived at its decision and what the time target is for completing various stages.
35. There was a delay in determining the case should be urgent, rather than non-urgent. This is fault. Furthermore, the Council failed to make a record of the decision to explain why it changed the urgency.
36. Even though Ms C only told the Council about her operation three weeks in advance, there was an unreasonable delay in the Council installing Ms C’s new door entry system. This should have been installed within about two and a half months but was instead installed six months after her assessment.
37. If the adaptations had gone ahead, the Council said they would have been completed in November 2020. This would have meant it would have taken one year and five months to complete the entire process. This is an unreasonable delay and more than thirteen months longer than the time it should have taken according to the guidance.
38. The Council failed to assess in August 2020 how Ms C’s unmet needs and/or any potential risks could be managed until she would move to another property. This is faut. The Council has acknowledged that and said it would do this as soon as possible.
39. In terms of injustice: Ms C should have been in a position to have started to enjoy the adaptations she needed, within a reasonable timescale. Taking the government time targets into account, this should certainly have been achieved by December 2019. The fact she was not able to do this, is an injustice. Although there were some risks involved with regards to the mixed lever taps and the way she accessed the high kitchen cupboard, she only told the Council about the risk of the latter in August 2020. Furthermore, I have not seen evidence Ms C came to any actual harm due to the delays. Nevertheless, the delays themselves and any perceived avoidable risk, no matter how small, would have resulted in some distress to Ms C.

Agreed action

40. I recommended that, within fours weeks of my decision, the Council should:
• Apologise for not installing the adaptations within a reasonable time scale. It should also pay her £1,500.
• Remind the OT service of the importance to discuss and clearly record how any needs and risks will be managed in the interim
41. I also recommended that within three months of my decision, the Council should:
• Review its policy, the system and the resources it has in place for ensuring necessary adaptations are delivered in a timely manner. This should include:
1. Agreeing separate time targets for non-urgent and urgent cases, that are in line with government guidance.
2. Ensuring clients are told in writing what priority their case is, explaining why it has been assigned that priority and what the Council’s official target is for starting / completing the works.
42. The Council has told me it has accepted my recommendations.

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Final decision

43. For reasons explained above, I have decided to uphold Ms C’s complaint.
44. I am satisfied with the actions the Council will carry out to remedy this and have therefore decided to complete my investigation and close the case.

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Investigator's decision on behalf of the Ombudsman