Summary: Mr B says the Council failed to follow through with an occupational therapy assessment it agreed to carry out six months after the first visit and failed to involve him in the later visits. There is no evidence the Council agreed to carry out a further visit after six months but the Council accepts Mr B should have been involved in the later visits. That did not result in Mr B’s mother missing out on any provision but led to Mr B having to go to time and trouble to pursue the complaint. An apology and payment to Mr B is satisfactory remedy.

The complaint

1. The complainant, whom I shall refer to as Mr B, complained the Council:
• failed to keep to a plan agreed in January 2020 to arrange a further occupational therapy assessment for his mother six months later; and
• failed to ensure he was involved in the occupational therapy visits which took place in March and July 2020 when the Council knew he had been representing his parents throughout.
2. Mr B says those failures meant his mother missed out on an adaptation to her property which would have enabled her to enjoy another year of normal bathing and sleeping in her own bed rather than in the lounge.

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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 an injustice, we may suggest a remedy. The Ombudsman cannot question whether a Council’s decision is right or wrong simply because Mr B disagrees with it. He must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, sections 26(1), 26A(1), as amended and 34(3))
4. 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

5. As part of the investigation, I have:
• considered the complaint and Mr B's comments;
• made enquiries of the Council and considered the comments and documents the Council provided.
6. Mr B and the Council 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

What should have happened

7. Section 9 of the Care Act 2014 (the Act) refers to assessment of an adult’s needs for care and support. It says:
• Where it appears to a local authority that an adult may have needs for care and support, the authority must assess:
• (a)whether the adult does have needs for care and support, and
• (b)if the adult does, what those needs are.
8. The Act says a local authority, in carrying out a needs assessment, must involve:
• (a)the adult,
• (b)any carer that the adult has, and
• (c)any person whom the adult asks the authority to involve or, where the adult lacks capacity to ask the authority to do that, any person who appears to the authority to be interested in the adult’s welfare.
9. The Metropolitan Home Improvement Agency is the organisation that carries out occupational therapy assessments for disabled facilities grants on behalf of the Council. The referral criteria states an occupational therapy assessment can take up to 6 months for nonurgent referrals. Priority 2 referrals require an occupational therapy assessment within 2-4 weeks.

What happened

10. Mr B’s mother has dementia as well as some other medical difficulties. In November 2019 the Council received a referral for a care needs assessment for her. When the Council spoke to Mr B about the case in January 2020 he asked for an occupational therapy assessment for a stairlift as his mother was having difficulty using the stairs.
11. The Council’s occupational therapist carried out an assessment in January 2020. Mr B and his mother and father were present at the visit. The occupational therapist suggested some interim changes to the stairs which Mr B’s parents declined. Alternative stair arrangements were agreed. The occupational therapist told Mr B a referral would be made for a major adaptation for the long term. The occupational therapist completed the referral and noted it was for standard priority. The referral was for Mr B’s mother to access essential facilities including washing, toilet and sleeping with a view that a stairlift may be a consideration to increase her safety mobilising on the stairs. The occupational therapist sent the referral to Metropolitan Housing Trust Ltd which is commissioned by the Council to run the home improvement agency service which deals with all aspects of disabled facilities grant referrals and applications.
12. An occupational therapist from the Metropolitan Housing Trust Ltd visited to carry out an assessment in March 2020. Mr B’s mother and father were present at the assessment but Mr B was not present. Mr B’s father told the occupational therapist the family were managing and did not need adaptations. The occupational therapist advised Mr B’s father to seek a further referral if needs changed in the future.
13. Mr B contacted the Council later in March to report his mother was having more difficulty managing the stairs. The Council re-prioritised the case to priority 2. The Council told Mr B there could be a delay carrying out the occupational therapy assessment due to Covid 19.
14. An occupational therapist visited to complete an assessment on 14 July. Mr B was not present at the visit but his father and mother were. The occupational therapist recorded that a stair lift was contraindicated in Mr B’s mother’s case due to her reduced cognition. Mr B’s father told the occupational therapist adaptations to the property were not required.
15. In April 2021 Mr B contacted the Council as his mother was now mostly bedbound. Downstairs living has since been created so Mr B’s mother can remain downstairs. A further assessment in October 2021 reported Mr B’s mother and father were happy with the downstairs living arrangement.
16. The Council intends to bring back the occupational therapy assessments for disabled facilities grants in-house from April 2022.

Analysis

17. Mr B says the Council failed to keep to a plan agreed in January 2020 to arrange a further occupational therapy assessment visit for his mother in six months. Having considered the documentary evidence I have not identified any agreement to carry out a further assessment in six months time. Instead, the documentary evidence shows the occupational therapist agreed to some interim adaptations for Mr B’s mother and to make a referral for a major adaptation. Given the timescale for carrying out occupational therapy visits for standard priority major adaptations was six months at the time I consider it likely, on the balance of probability, Mr B misunderstood the information the occupational therapist provided and believed that meant an agreement had been made to carry out a further occupational therapy assessment in six months. That was a misunderstanding though. In Mr B’s mother’s case it did not take six months for the referral to be dealt with as an occupational therapist from the agency commissioned by the Council to complete assessments carried out the major adaptations assessment in March 2020. As I have found no evidence the Council agreed to carry out a reassessment in six months time and as I am also satisfied the Council arranged for an occupational therapy assessment for the major adaptation I have no grounds to criticise it.
18. I understand Mr B’s concern though about the assessments which took place in March and July 2020. Mr B says because he was advocating on behalf of his parents the Council should have involved him in the assessments. I consider it likely if the Council’s occupational therapist had carried out the March and July 2020 assessments Mr B would have been involved given the occupational therapist met with Mr B in January 2020. However, for the March and July 2020 assessments the Council used the agency it has commissioned to produce occupational therapy assessment reports. The Council is able to contract out that function and I cannot criticise it for doing so. The Council accepts though it would have been good practice to contact Mr B and involve him in the assessments given he had taken part in the January 2020 assessment. The Council is intending to bring back the occupational therapy assessments in-house from April 2022 which will hopefully prevent the same problem happening again.
19. Mr B says if he had been involved in the assessments in March and July 2020 the outcome would have been different. For both those assessments the documentary evidence is clear Mr B’s father advised the occupational therapist he and his wife were coping and did not require adaptations. Mr B’s father therefore declined any adaptations on both occasions. For the July 2020 assessment I would have expected the contractor carrying out the assessment to identify an issue given two separate referrals had been received (one in January 2020 and one in July 2020) which had requested adaptations. When Mr B’s father declined those adaptations on two occasions I would have expected the contractor to liaise with the Council as there was clearly an issue which needed to be resolved. That would likely have then involved the original occupational therapist who could have contacted Mr B to arrange a further visit. Failure to investigate matters further following a second refusal in July 2020 is fault. As the agency carrying out the occupational therapy assessment was doing so on behalf of the Council it is the Council that is responsible for any fault in the actions of the agency.
20. It is clear Mr B believes if he had been involved in either the March or July 2020 assessment his parents would have accepted the stairlift and his mother would have had access to normal bathing and been able to sleep in her own bed rather than downstairs. Mr B therefore believes his mother’s quality-of-life was severely affected. I understand why he would take that view. However, Mr B’s mother and father own the property and would have had to provide permission for the Council to complete any works. Mr B’s father had clearly declined adaptations in March and July 2020. In addition to that, it is clear from the notes from the January 2020 assessment that although Mr B was involved it was his parents that were making the decisions. I say that because I note the records from the January 2020 assessment show Mr B’s father told the Council his wife had declined the initial occupational therapy recommendation for the stairs. The record of a later discussion with Mr B also shows when the Council suggested an alternative Mr B explained he would need to discuss that with his parents. In those circumstances I cannot say Mr B’s mother and father would have accepted the stairlift if Mr B had been involved in either the March or July 2020 assessment.
21. I have also taken into account the fact that both the March and July 2020 assessments recorded that a stairlift was not suitable for Mr B’s mother due to her dementia meaning that she would not be able to operate the controls. The July 2020 assessment also recorded the occupational therapist’s view that as Mr B’s mother’s abilities would deteriorate further transfers on and off the stairlift would become more difficult and a stairlift was therefore not recommended. Given the occupational therapist’s view it seems likely, on the balance of probability, a stairlift would not have been installed even if Mr B’s parents had accepted it as the occupational therapist did not consider it suitable. I therefore could not say failure to involve Mr B in the March and July 2020 assessments meant his mother missed out on an adaptation to her property. However, I consider Mr B has suffered an injustice as he has experienced frustration at not being included in the assessments and has had to go to time and trouble pursuing his complaint. To remedy that injustice I recommended the Council apologise to Mr B and pay him £250. The Council has agreed to that recommendation.

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Agreed action

22. Within one month of my decision the Council should apologise to Mr B and pay him £250.

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Final decision

23. I have completed my investigation and find fault by the Council in part of the complaint which caused Mr B an injustice.

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Investigator's decision on behalf of the Ombudsman