Summary: Miss X complains the Council has failed to meet her care needs since May 2018. The Council’s care and support planning has been inadequate. It needs to review Miss X’s needs and update her care and support plan to make sure it accurately reflects her needs.

The complaint

1. The complainant, whom I shall refer to as Miss X, complains the Council is failing to meet her care needs.

Back to top

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, sections 30(1B) and 34H(i), as amended)

Back to top

How I considered this complaint

4. I have:
• considered the complaint and the documents provided by Miss X;
• discussed the complaint with Miss X;
• considered the comments and documents the Council has provided in response to my enquiries; and
• shared a draft of this statement with Miss X and the Council, and invited comments for me to consider before making my final decision.

Back to top

What I found

5. Miss X has physical health problems which affect her mobility and a personality disorder. In 2017 she spent some time in hospital followed by a period of residential respite care. When she returned home she received four calls a day. But by 2018 she was receiving three calls a day: late morning; late afternoon; and mid-evening.

Assessments and care and support plans

6. In March 2018 the Council reassessed Miss X’s needs. The assessment says she could not achieve these outcomes (which had also been the case in 2017):
• managing and maintaining nutrition;
• maintaining personal hygiene;
• managing toilet needs;
• being appropriately clothed;
• maintaining a habitable home environment; and
• being able to make use of the home safely.
7. The assessment says Miss X wanted to: remain in Stockport; regain her base level mobility; remain healthy; retain her dignity; and remain safe. It says she needs help with: cleaning her property; personal care; emptying the commode; de-cluttering; laundry; changing bedding; bidding for alternative accommodation; having lunch delivered; and carers to help with breakfast and tea. The care and support plan says the Council would:
• provide a 30-minute call in the mornings to help with personal care, meal preparation and emptying the commode;
• arrange for a hot meal to be delivered at lunchtimes;
• provide a 30-minute call in the evenings to help with personal care, meal preparation and emptying the commode;
• provide one hour a week to help with decluttering and post;
• provide one hour a week to change the bed and help with laundry.
8. The Council did not identify a personal budget.
9. The Council visited Miss X on 17 April. The next day it wrote saying it would implement changes to her care and support plan on 16 May:
• 30-minute call at 11.30 to help with personal care;
• a hot lunch delivered each day from 16 May;
• 30-minute call at 20.00 to help with personal care and prepare flask of soup etc;
• 1 hour a week to help with decluttering and changing the bed.
10. The Council noted it had offered Miss X an early morning call, but she did not want this. It said it would review the care and support plan two weeks after implementing it.
11. Following advice from the NHS, the Council implemented a “strict routine” of limiting each call to 15 minutes on food preparation and 15 minutes of personal care. The Council’s records say Miss X agreed to this. The Council did not update her care and support plan to reflect the change.
12. The Council called Miss X on 12 June to review her care. Its record of the call says she “suggested she had adjusted to the new care plan” and aimed to become more independent. Miss X said she was not happy with the hot meals but was resigned to the change in her care and support plan.
13. In January 2019 the Council decided to send two carers to visit Miss X.

Records of the carers’ visits

14. I have read the records of the carer’s visits from May 2018 to January 2019. There are too many to list here, so I summarise the key contents below.
15. From 16 May Miss X received two calls a day: late morning and mid evening. She also had a hot meal delivered each lunchtime. The carers’ records of their visits say they:
• prepared food and drinks, including hot food;
• emptied/cleaned the commode;
• provided personal care when Miss X agreed to this;
• applied cream prescribed by a GP to Miss X’s body;
• when required, changed the sheets on the bed or helped Miss X do this;
• filled/emptied the washing machine;
• disposed of food;
• cleaned the fridge;
• put shopping away.
16. Miss X regularly declined help with personal care because she:
• was not up to it; or
• said she would do it herself; or
• did not want a male carer; or
• was on the telephone; or
• had other people with her; or
• other tasks did not allow enough time.
17. Sometimes the carers refused to carry out tasks which were due to be covered by the weekly calls (e.g. moving boxes) or to cook food which would take too long.
18. The first record of a weekly hour-long call was on 11 July. On 18 July Miss X cancelled it. There are no records of calls on 8 August (possibly cancelled by Miss X) or 19 September. On the hour-long calls the carers would do some but not all of these tasks:
• changed the bed;
• put the washing machine on;
• hang washing up;
• empty/clean the commode;
• wash up and put things away;
• vacuum;
• tidy up;
• clean the floor;
• dispose of out of date food;
• put rubbish out;
• sort through papers, including shredding;
• washed Miss X and applied cream;
• prepare drinks
19. Twice Miss X declined having her hair washed. She was advised to say when she wanted it washing.

Miss X’s complaints

20. In July Miss X complained about:
• carers and managers bullying her;
• a carer accusing her of running into her in her wheelchair;
• a carer refusing to make a drink or butter two scones for her, despite there being 15 minutes left;
• only getting two calls a day;
• being sent male carers to provide personal care;
• carers visiting in twos.
21. The Council decided not to pursue Miss X’s concerns about bullying via its safeguarding procedures. Miss X agreed to this but said she did not want the carers to return.
22. In August Miss X complained again about male carers visiting her. She said she would want female carers two or three times a week for personal care. Ms X also said she felt threatened having two carers visit her.
23. In September Miss X complained about:
• carers visiting in twos;
• the number of new carers;
• a carer burning her rice pudding;
• not receiving hot food apart from those delivered at lunchtimes;
• not providing an emergency carer to empty her commode when she had diarrhoea.
24. In October Miss X complained about:
• a carer leaving food in her kitchen;
• carers not providing hot meals;
• not getting enough calories from the hot meals delivered;
• not taking account of her food preferences;
• a carer frying fish fingers, rather than heating them in the oven, which made her sick;
• the lack of calories in her hot food;
• carers refusing to cook fish for her;
• carers removing her care records.
25. In November Miss X complained about:
• a carer not emptying her commode;
• a carer not locking her door;
• constant changes in carers.
26. In December Mss X complained:
• a carer being manipulative with her.
27. In January 2019 Miss X complained about:
• two carers visiting her;
• only receiving two calls a day, rather than four;
• being left without care after refusing to accept calls from two carers;
• not having a bath or hair wash since 2017;
• not being told why she had to have two carers;
• wanting surveillance equipment installed so only one carer could visit;
• carers revealing her key safe code to her neighbour;.
28. On 22 January 2019 the Council responded to Miss X’s complaints. It said:
• she had made 23 complaints about her care since September 2018, including allegations of poor attitude, inadequate meals, stealing a bottle of water, taking a book without her knowledge, not locking the door properly;
• she had complained 21 times about having two carers;
• it was sending two carers because of the level of accusations;
• Miss X was asking carers to do tasks not in her care plan and making complaints whether they did what she asked or not;
• it was not prepared to install recording equipment as the costs would be disproportionate to the benefits;
• it would review Miss X’s care on 23 January and again in three months’ time. If at that point she was satisfied with the care being provided it would consider returning to a single carer visit;
• it would not give Miss X a “personal budget” to employ her own carers because she had debts which needed to be cleared before it would consider a personal budget.

Is there evidence of fault by the Council which caused injustice?

29. After assessing Miss X’s needs in March 2018, the Council decided to meet them by providing two, rather than three, calls a day. It could do this as it started providing a hot meal each day. I cannot find fault with the Council over that. It is entitled to identify the most cost-effective way of meeting needs.
30. The Council also identified the need for two hour long calls a week but never provided them. There is nothing to explain why that was the case. That is fault by the Council. In April the Council told Miss X it would provide one hour long call a week but did not update her care and support plan. That is also fault by the Council. There is nothing to explain the reason for this decision or how the weekly need could be met within one hour, rather than two. Following advice from the NHS (see paragraph 11 above), the Council made other changes to the way it delivered care. This too should have resulted in an update to Miss X’s care and support plan.
31. The records of the care being provided to Miss X show it is not in line with her care and support plan. In particular, it is clear her need for help with bed changing and washing bedding is far greater than reflected in the care and support plan. The latter suggests it is a weekly need, but the care records show it is more frequent than that. The need to change and wash the bedding is therefore encroaching on the time provided for meeting her other needs.
32. There is not enough evidence for me to say these faults caused significant injustice to Miss X. The carer’s records show Miss X regularly refused personal care. They show it has been open to her to have her hair washed and could ask for this whenever she wanted. It appears Miss X’s main concern has been around the provision of hot food. But the Council is meeting that need by having a hot meal delivered each day. Carers have continued to heat food up for Miss X, but have refused to prepare more elaborate meals. That is not fault by the Council.
33. Nevertheless, the Council should review Miss X’s needs and update her care and support plan, so it properly reflects her needs and the care being provided to meet them.
34. Neither Miss X’s current care and support plan, nor the earlier versions the Council has sent to me, identify her personal budget. That is fault by the Council as the Care and Support Statutory Guidance (Statutory Guidance) says a care and support plan must include the personal budget. While I cannot identify any significant injustice as a result of this, the Council needs to correct this failure.
35. More significantly, the Council has when writing to Miss X (see paragraph 27 above) confused personal budgets with direct payments. Everyone should have a personal budget. They also have the right to ask for direct payments. When Miss X did this the Council said it would not give her direct payments because of her debts. But that did not mean she was ineligible for direct payments. The Statutory Guidance says councils should “take all reasonable steps” to provide support to people who might need help managing direct payments. This will often involve an agency contracted by a council to provide this help. The Council needs to reconsider Miss X’s request for direct payments.

Back to top

Agreed action

36. I recommended the Council within four weeks:
• reviews Miss X’s needs and updates her care and support plan; and
• reconsiders her request for direct payments.

The Council has agreed to do this.

Back to top

Final decision

37. I have completed my investigation as the Council has agreed to take the action I recommended.

Back to top

Investigator's decision on behalf of the Ombudsman