The Ombudsman's final decision:
Summary: Mr B complains that the Council failed to provide him with adequate support and the carer’s’ assessment it completed for his mother was late and inadequate. He also says the Council failed to properly assess his needs and provide a service to meet his eligible needs. The Ombudsman finds the Council delayed in completing a carer’s assessment and, when the assessment was done, it was not as comprehensive as it should have been. There was also fault in that officers who assessed Mr B’s needs did not have autism training or previous experience of working with adults with autism and did not consult anyone with such experience. The Ombudsman has recommended a remedy for the injustice suffered by Mr B.
- Mr B complains that:
- The Council failed to provide him and his mother with adequate support after they requested an assessment for supported living. He says the Council failed to help him secure supported living accommodation and to support his mother in her role as carer, delaying in carrying out a carers assessment. When such an assessment was completed, it was inadequate and failed to result in the provision of any support;
- the Council removed his funding/direct payment for his placement in 2017 even though there was no change in his needs or circumstances. This was despite a written assurance in April 2016 that funding “will only stop if he is deemed not eligible following the outcome of any re-assessment”;
- the Council has failed to properly assess his needs and provide a service to meet his eligible needs. The latest assessment carried out in November 2017 is inadequate and inaccurate and the Council has failed to properly explain why he is not eligible for the support he previously received when there has been no change in his circumstances;
- no assessments have been undertaken in relation to his ability to live independently;
- the Council has delayed unreasonably in providing a Care Act 2014 advocate for him; and
- the Council has failed to provide him with support to manage his finances.
The Ombudsman’s role and powers
- We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word ‘fault’ to refer to these. We cannot question whether a council’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), as amended)
- 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)
How I considered this complaint
- I have considered all the information provided by Mr B, made enquiries of the Council and considered its comments and the documents it provided.
- I have written to Mr B’s solicitor and the Council with my draft decision and considered their comments.
What I found
- 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. They must provide an assessment to all people regardless of their finances or whether the local authority thinks an individual has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and, where suitable, their carer or any other person they might want involved.
- Where an individual provides or intends to provide care for another adult and it appears the carer may have any needs for support, local authorities must carry out a carer’s assessment. Carers’ assessments must seek to find out not only the carer’s needs for support, but also the sustainability of the caring role itself. This includes the practical and emotional support the carer provides to the adult.
- Where the local authority is carrying out a carer’s assessment, it must include in its assessment a consideration of the carer’s potential future needs for support. Factored into this must be a consideration of whether the carer is, and will continue to be, able and willing to care for the adult needing care. (Care and Support Statutory Guidance 2014)
- The Care and Support (Eligibility Criteria) Regulations 2014 sets out the eligibility threshold for adults with care and support needs and their carers. The threshold is based on identifying how a person’s needs affect their ability to achieve relevant outcomes, and how this impacts on their wellbeing. To have needs which are eligible for support, the following must apply:
1. The needs must arise from or be related to a physical or mental impairment or illness;
2. Because of the needs, the adult must be unable to achieve two or more of the following:
- Managing and maintaining nutrition;
- Maintaining personal hygiene;
- Managing toilet needs;
- Being appropriately clothed;
- Being able to make use of the adult’s home safely;
- Maintaining a habitable home environment;
- Developing and maintaining family or other personal relationships;
- Accessing and engaging in work, training, education or volunteering;
- Making use of necessary facilities or services in the local community including public transport, and recreational facilities or services; and
- Carrying out any caring responsibilities the adult has for a child.
3. Because of not achieving these outcomes, there is likely to be a significant impact on the adult’s well-being.
- Where local authorities have determined that a person has any eligible needs, they must meet these needs. When a local authority has decided a person is or is not eligible for support it must provide the person to whom the determination relates (the adult or carer) with a copy of its decision.
- The Care Act 2014 gives local authorities a legal responsibility to provide a care and support plan (or a support plan for a carer). The care and support plan should consider what 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. When preparing a care and support plan the local authority must involve any carer the adult has. The support plan may include a personal budget which is the money the council has worked out it will cost to arrange the necessary care and support for that person.
- Mr B has Asperger’s syndrome, a learning disability and Obsessive Compulsive Disorder (OCD) mainly relating to eating, drinking and personal care.
- Mr B was living with his mother, Mrs C, and her husband. Mr B was attending a voluntary placement at a refuse company two days per week. He had to get up at 4 am to complete his personal care routine to be ready for work on time. In addition, the Council provided a direct payment of £65 per week to enable Mr B to attend an “active group”. This met his identified need of developing personal relationships.
- Mr B wanted to move into his own property and Mrs C was struggling to cope so she began trying to obtain supported living accommodation for him. She approached the Council for a support needs assessment for Mr B in April 2015.
- An assessment was completed which indicated Mr B met the eligibility criteria set out in the Care Act 2014 with regard to developing and maintaining relationships and maintaining a habitable home environment. His support plan was completed on 14 September 2015. It stated Mr B’s outcomes were to find paid work, live independently and meet people his own age.
- Mr B was assessed as being able to live independently and, in October 2015, he was offered a general housing association flat with no support. He refused it because he wanted a property of a higher standard with a wet room. Mrs C said Mr B needed more support than the Council had assessed him as needing. She wanted him to have a supported living placement. But the Council was satisfied Mr B did not require support based on his assessment. Mr B’s social worker explained supported living would be too restrictive because he did not need this level of support. She suggested Mr B applied for general social housing.
- In January 2016 another social worker, Officer X, took over Mr B’s case. Mrs C told her she was trying to find supported living accommodation for Mr B. Officer X explained Mr B was not eligible for supported living funding from the Council.
- In April 2016 Mrs C contacted Officer X asking her to arrange for Mr B to be put on the waiting list for Extra Care Housing. Officer X explained she could not do this because Mr B did not meet the criteria for support and, in any event, the properties in question were for the over 55’s. Mrs C said she did not agree with the assessment. She said she was struggling to cope because of Mr B’s OCD and had attempted suicide the previous year. She felt Mr B was being discriminated against because he could drive. Officer X explained that assessments consider the strengths of the person along with the areas where support is needed. The Council has a duty to promote independence and Mr B may be at risk of becoming de-skilled if he were to move somewhere with a high level of support.
- In June 2016 Mrs C sent the Council a letter from her GP explaining she was being treated for depression and seeing the mental health team and that she had taken an overdose in 2015.
- Mrs C made a complaint about the assessment and resulting support plan. The locality manager responded on 21 July 2016. She agreed to visit Mr B and Mrs C to discuss the areas of the assessment they considered were not representative of Mr B’s needs.
- The case was reallocated to Officer Y who visited Mr B on 3 August 2016. She considered the previous assessment and concluded little had changed. Mr B was desperate to move into his own tenancy and Mrs C had her own mental health concerns. Following this meeting Officer Y contacted Mr B’s doctor to request a referral for support with his OCD.
- In November 2016 Officer Y visited Mr B and Mrs C to carry out a re-assessment of Mr B’s needs. Mr B explained his voluntary refuse job was due to end shortly. He was very upset by this. Officer Y offered to make a referral to the Supporting Independence Service (SIS) to help him find another position. She explained it was unlikely Mr B would meet the criteria for funding for accommodation.
- The re-assessment was completed on 24 November 2016 and signed by Mr B and Mrs C on 24 January 2017. It stated Mr B wanted to move to supported living with other people. Mrs C said she was getting older and Mr B was becoming more demanding. She could no longer cope and was having suicidal thoughts. Mr B’s relationship with his stepfather was very strained which was having an effect on her mental health. She wanted Mr B to move to supported living accommodation she had found. The assessment stated “Although [Mrs C’s] needs and views have been included in this assessment I will offer [her] a separate carer’s assessment”.
- The assessment explained that Mrs C supported Mr B with food preparation, cooking, medication, housework and shopping. These were all tasks Mr B could complete himself but Mrs C supported him because of the amount of time he took to complete them. Both she and Mr B were aware he would need to take on these tasks when living independently.
- The assessment concluded Mr B only had one eligible need so he did not meet the eligibility criteria and was not eligible for support. The “active group” provided Mr D with support in relation to his eligible need (developing and maintaining relationships) and he could self-fund this.
- Mrs C’s MP wrote to the Council on 29 November 2016 asking why Mr B did not meet the criteria for accommodation and stated Mrs C had not received a carers assessment despite this being mentioned to her the previous year and despite the pressures she was under.
- The Council responded on 9 December 2016 explaining that, from Mr B’s current assessment, he required less than three hours support per week so he was not eligible for supported living accommodation. The Council’s view was that Mr B could access the community independently and had been in regular employment over the years. He had been advised to visit his GP for support with his OCD. Although Mr B had routines which were important for him to follow each day because of his OCD, he does not need support with these routines. Officers were satisfied that, if Mr B lived in his own tenancy, a lot of his anxiety would be alleviated because much of the tension was caused by the amount of time he spent in the shared bathroom at Mrs C’s house.
- The Council considered Mrs C’s needs had been captured as part of the assessment and re-assessment process. It was satisfied she had support from the Carers Association but it completed a separate carer’s assessment in December 2016.
- In December 2016 Officer Y sent the completed assessment to Mr B and asked to meet with him to discuss it. She also sent him a link to the local housing association so he could look for suitable properties.
- A few days later Officer Y telephoned Mr B to discuss the re-assessment. She spoke to Mrs C who said she could not cope anymore and wanted support to find Mr B supported living accommodation. Officer Y again explained the re-assessment showed Mr B did not meet the eligibility criteria for services so he would not be receiving support from the Council apart from an offer of a referral to SIS for support in finding daytime opportunities and employment. She told Mrs C that direct payments for Mr B’s active group would end in February 2017 because he did not meet the criteria for services. Mrs C was extremely upset by this because his attendance at the group provided her with some respite.
- In January 2017 Mrs C and Mr B met with Officer Y and the locality manager to discuss the assessment. They explained direct payments would not end until February to enable time for SIS to support Mr B to find alternatives or he could choose to self-fund his day at the active group. Mrs C was very upset stating officers had no understanding of Mr B’s needs.
- In February 2017 Officer Y made a referral to SIS stating the priority was to help Mr B find housing. An officer from SIS visited Mr B and Mrs C and explained her role was to support Mr B to find independent living. She also agreed to help him find a work placement. Mrs C explained Mr B was waiting for the outcome of a PIP assessment before deciding whether to apply for social housing or if he would be able to self-fund a supported living placement.
- Towards the end of March 2017 the SIS worker found Mr B a placement at a recycling plant. She told Mrs C who said Mr B did not want to work in a recycling plant because he had done that before and had too much going on at the time and could not cope with a work placement as well. She said they would contact SIS if they needed anything else. Mr B then queried whether the placement involved waste management as well as recycling. The SIS worker confirmed it did and Mr B agreed to email the employability officer about it. But, in April 2017, Mrs C sadly took her own life. The police contacted the Council requesting an urgent assessment of Mr B. His stepfather said he was unable to support him and wanted him to leave the property so a placement was needed urgently. Mr B was admitted to hospital because of severe emotional trauma and risk of suicide.
- On 22 May 2017 a social worker, Officer Z, began a re-assessment of Mr B on the ward to decide whether he had capacity to manage his finances and whether he needed supported living. Officer Z established Mr B had never managed his own finances but he could talk about his benefits and knew how much he had in his bank account. Officer Z concluded Mr B would need support and guidance with this for a time but should then be able to manage his finances himself.
- The assessment was completed in June 2017 and recommended Mr B receive a budget to enable him to be supported to live in his own flat.
- On 20 June 2017 there was a discharge planning meeting. Mr B’s solicitor attended together with his brother and sister-in-law. Officer Z explained Mr B’s strengths but his solicitor argued the level of support being offered was not enough because he had no informal support to go along with it.
- On 29 June Officer Z met with Mr B, his solicitor and his advocate, Mr D, who said there were numerous errors in the assessment.
- On 5 July 2017 Officer Z visited Mr B with his advocate. Officer Z considered there was no discernible change in Mr B’s level of care and support needs and the Council’s offer was a good one. Staff on the ward confirmed Mr B had no support needs. Officer Z considered Mr B needed 10 hours support per week for a three-month period while he settled into his own accommodation.
- On 4 August 2017 a multi-disciplinary team meeting was held on the ward. Mr B, Mr D, social workers and medical staff attended. Before the meeting Officer Z discussed with Mr D the Council’s intention to offer Mr B a place at Park House (not its real name) for a period of stability and assessment away from the ward. Park House provides respite care and support for people with learning disabilities and/or autism.
- A Care Act advocate was appointed in September 2017 and Mr B was placed at Park House. Officer R from SIS was appointed as a secondary worker to assess what level of care and support he would need in the future in relation to things such as life skills, employment, community inclusion, health and safety in the home, nutrition, diet and healthy eating and money management.
- Officer R visited Mr B on 14 September 2017 with a colleague. She told Mr B she would like to observe him complete some life skills to decide if he needed support in the future. The care manager at Park House said Mr B had been changing his own bedding, tidying and hoovering his bedroom, making his bed and using the washing machine and tumble dryer to do his laundry. Mr B had also been travelling in his car to meet friends and attend a club but he did need some support to take his medication.
- A few days later Officer R and her colleague visited Mr B to obtain further information.
- On 25 September 2017 Officer R visited Mr B to observe him tidy his bedroom, change his bedding and do his laundry.
- Mr B’s solicitor contacted social services stating she was concerned at how low in mood he was and that he had started self harming. She said he was spending long periods of time alone in his room, had no structure to his days and no timetable and was finding this very difficult. She asked the Council to set out the steps it proposed to take with estimated timescales.
- The operations manager responded explaining the efforts social workers were making to engage with Mr B but he often declined. He explained Park House staff had on several occasions tried to plan a timetable with Mr B but he would not engage saying it would depend on what he felt like doing at the time. Where Mr B had agreed to join in activities in advance he would often decline at the time. The manager explained he could not give firm timelines for progress as it was necessary to work at Mr B’s pace.
- During October and November 2017 Officer R visited Mr B several times to discuss life skills and observe him carrying out tasks such as shopping, withdrawing cash from the cash machine and putting air in his car tyres.
- A re-assessment of Mr B’s needs was completed in November 2017 by Officer Z. The assessment explained Mr B’s functional abilities were assessed by an OT just before he left the ward. She carried out a shopping and cooking assessment and concluded Mr B “was able to function performing the occupation of shopping for an evening meal and safely heating this up”. Since Mr B moved to Park House an SIS officer had worked with him to help assess his functional abilities. Both the OT and the SIS worker indicated Mr B could undertake daily living activities.
- Having considered the information from previous assessments and from the functional abilities assessments carried out by the OT and the SIS, Officer Z concluded that, with targeted support, Mr B would be able to make his own meals and maintain his own living environment. The assessment stated that Mr B would initially require support with food shopping and meal preparation when he moved to his own property.
- Towards the end of November 2017 another social worker, Officer T, began searching for accommodation for Mr B with 10 hours support per week. She found a potential flat that met the criteria.
- The Council held a meeting with Mr B, his solicitor, Mr D and members of his family. Mr D said Mr B did not accept the re-assessment because it did not reflect his needs and could not generate the budget he needed. His solicitor had arranged an independent assessment to be undertaken in January 2018. Mr D said officers presumed Mr B could manage his money but he could not. Officer Z explained about the accommodation and arranged to take Mr B to visit.
- Mr B viewed the accommodation and wanted to accept it. But the care provider had to carry out an assessment of his suitability first.
- Following the assessment, the care provider explained they could not accept Mr B because his needs were not complex enough. They did not feel the placement was right for him because he was so independent. Mr B was extremely disappointed by this and felt let down by social services.
- Officer T continued to search for suitable accommodation. She arranged for another supported housing provider to assess Mr B for housing with 10 hours support per week. The provider felt 10 hours per week was sufficient to support Mr B and was happy to find accommodation for him. It agreed to work with him to create a budget plan to ensure he could manage the tenancy.
- In January 2018 a new referral was made to SIS to support Mr B with the move to his flat.
- The housing provider set a budget plan for Mr B and identified several properties for him to look at. But Mr B and his family were concerned that staff would not be present 24 hours a day. The provider felt that, with Mr B’s assessed level of need, he would not be eligible for supported living facilities.
- Meantime, another care provider expressed interest in supporting Mr B at a supported living unit.
- Officers agreed that, to avoid a repeat of the disappointment Mr B felt when he was not accepted for services after viewing a property, they would continue to source accommodation and Mr B would be assessed by any potential housing companies and would only view properties once he was accepted. The SIS worker agreed to support Mr B to view the properties.
- The supported housing provider met with Mr B again. She told the Council Mr B was reluctant to proceed because he was waiting for an independent assessment at the end of the month. She said Mr B considered he needed more than 10 hours support per week but could not identify why. The housing provider had identified several possible properties for Mr B to view which would provide 10 hours support per week and which were within his budget. Mr B declined to view them until after the independent assessment had been carried out and his PIP awarded. He was awaiting a PIP tribunal. The provider confirmed that, until Mr B agreed, they could not move forward.
- Another housing provider expressed an interest in providing accommodation for Mr B with 10 hours support per week. The provider visited Mr B to carry out an assessment. He stated, “whilst it is clear that [Mr B] require some support around his daily living skills, in our opinion, he also requires an awful lot of on-going emotional support and has clearly been massively affected by his experiences over this last 12 months”. He went on to say, “if you focus on him owning his own car, you can be forgiven for thinking he is far more able than he actually is, scratch beneath the surface and you find a very vulnerable man who is at risk of slipping through the net”. The provider stated they would be happy to support Mr B at their property but he could not currently afford it due to his PIP being withdrawn.
- Mr B was very keen to move to the property but understood the difficulties with regard to affordability. He offered to use his savings until such time as he received his PIP.
- In January 2018 there was a meeting with Mr B and Mr D to discuss the financial implications of the move.
- In February 2018 Mr B moved to the supported living flat.
- The following week Officer T and Officer R visited Mr B to go through his support plan and give him weekly activity plans to help him with daily routines. Officer T went through the support plan in detail with Mr B. He pointed out things he wanted changed because he felt they were incorrect. Officer T agreed to amend these. Mr B signed the support plan with the amendments.
- Officer T visited Mr B again on 22 February 2018. He asked her to support him to put a weekly and daily timetable together which she did.
- In March 2018 the care provider told Officer T that, while Mr B had settled in well, he had become increasingly anxious and had been self-harming. He said this was because of the ongoing issues with his benefits. Support workers had discovered that his belongings were still in boxes stacked up in his room. They had been prompting him to sort through these and offering support but Mr B said all he could think about was his financial situation and found it difficult to focus on anything else. Since then he had been working with staff to sort through his things. The care provider confirmed that once Mr B’s PIP was reinstated, he would be able to afford to live at the flat but he did need to limit his spending for the time being and would need to use his savings to subsidise his weekly spending. Staff created a weekly budget planner so Mr B could see how much he was spending and what he needed each week. The care provider arranged for Mr B to have one-to-one time with staff each day to discuss any concerns and help him manage his anxieties. This was put on his daily planner so he knew who was supporting him each day.
Failure to help Mr B secure supported living accommodation
- Mr B says officers misled him about properties available in October 2014, October 2015 and June 2016. The properties suggested to him were social housing and not supported living placements.
- I find officers explained to Mr B and Mrs C on several occasions that Mr B was not eligible for supported living placements because he did not need this level of support. They were therefore aware the properties suggested were social housing and not supported living placements.
- There are no grounds to criticise the Council for failing to offer a supported living placement to Mr B because he was assessed as not being eligible for that level of support.
Failure to support Mrs C/delay in carrying out a carer’s assessment
- Mr B says the Council failed to support his mother in her role as carer. He says it delayed in carrying out a carer’s assessment and, when the assessment was completed, it was inadequate and failed to result in the provision of any support. Mr B says he and his mother were living in an intensely pressurised environment largely because of difficulties in the relationship between Mr B and his stepfather, the limited bathroom facilities and Mr B’s complex needs around his personal hygiene because of his OCD. Mrs C was left managing her own mental health difficulties and supporting Mr B. He says the Council has failed to acknowledge it let Mrs C down and apologise for this.
- I find Mrs C’s needs and views were included in Mr B’s assessment completed in December 2016. But a separate carer’s assessment was also completed in December 2016 which identified Mrs C was a member of the Carers Association and received support from them.
- Having reviewed the carer’s assessment, the Council accepts it was not as comprehensive, detailed or robust as it should have been. It has confirmed it will learn from this and improve practice for the future.
- I consider the Council should have completed a separate carer’s assessment sooner given that Mrs C was stating from April 2015 that she was struggling to cope and provided evidence from her GP in 2016 that she was suffering from depression and seeing the mental health team. I find the Council was also at fault in that the carer’s assessment completed in December 2016 was not as comprehensive as it should have been.
- It is not clear whether Mrs C would have received any more support if the assessment had been completed sooner or if it had been more comprehensive. But the uncertainty of whether this is the case causes Mr B a significant injustice.
Removal of funding/direct payment
- Mr B says no explanation has been given as to why he was no longer eligible for the support he had been receiving when there was no change in his presentation, needs or circumstances.
- The direct payment was stopped following the re-assessment completed in December 2016 which identified that Mr B was managing independently and did not meet the criteria for services. On 23 December 2016 the social worker told Mrs C the direct payment would end in February 2017. The Council believed Mr B could achieve greater levels of independence and community presence in other ways and SIS would work with Mr B to find alternative activities.
- I find the re-assessment is comprehensive and explains the reasons for the officer’s decisions. In the absence of fault, there are no grounds to question the decision that Mr B was not eligible for support.
- Mr B says no alternative activities opportunities were offered to him between December and March 2017 when SIS were supposedly working with him.
- I am satisfied SIS did find an alternative activity for Mr B. This was a work placement at a waste facility which is something Mr B is interested in. Mr B was initially offered a placement in recycling which he declined but then asked whether the placement also included waste management. SIS confirmed this was the case but, before Mr B could pursue this, his mother died.
Failure to properly assess Mr B’s needs and provide adequate support
- Mr B says the re-assessment completed in February 2018 is inaccurate and inadequate. He does not believe he has the skills currently to live on his own successfully. He has never previously lived alone, managed a house or household budget, looked after his own money, undertaken a weekly shop or cooked a proper meal. This was all done for him by his mother. He says he needs to have people around him as and when needed and help with daily living activities as well as support in managing his anxieties and mental health needs.
- The independent assessment carried out by an independent autism specialist in March 2018 concludes that the Council’s assessment is flawed because it does not offer any insight into Mr B’s communication difficulties and rigid thinking. It states his care and support needs have been significantly overlooked. It concludes that the Council is failing to meet his care and support needs which are complex. He needs skilled support from staff with a good understanding and experience of working with adults on the autistic spectrum. It says he needs support to plan a weekly menu and buy provisions and to help him develop strategies to manage his laundry.
- The Council says this assessment does not change its view and it intends to continue with the support plan dated February 2018.
- The re-assessment completed in November 2017 is detailed and Officer Z explained the reasons for his decisions. The support plan completed by Officer T in February 2018 took into account: previous assessments; the care provider’s assessment of Mr B’s support needs; the SIS worker’s functional assessment; the OT’s functional assessment and information from House X.
- The Council has been unable to confirm whether Officer Z, who was an agency worker, had any training in autism or any experience of working with adults with autism. It has however confirmed that Officer T has had no autism training and no previous experience of working with adults with autism.
- Statutory guidance issued in 2015 for local authorities to support implementation of the Adult Autism Strategy states that, from April 2015, the Care and Support (Assessment) Regulations 2014 would require local authorities to ensure a person undertaking an assessment of an adult’s care and support needs has suitable skills, knowledge and competence in the assessment they are undertaking, and is appropriately trained. The Regulations require councils when carrying out an assessment to consult a person who has expertise in relation to the condition or other circumstances of the individual whose needs are being assessed where it considers the needs of that individual require it to do so”. This is a matter for professional judgement.
- Statutory guidance issued in 2010 stated local authorities should be providing general autism awareness training to all frontline staff in contact with adults with autism. The 2015 guidance states that, in addition, local authorities are expected to have made good progress on developing and providing specialist training for those in roles that have a direct impact on and make decisions about the lives of adults with autism, including those conducting needs assessments.
- The care and support statutory guidance to support the Care Act regulations states “The Care Act strengthens this guidance in relation to assessors having specialised training to assess an adult with autism. The Act places a legal requirement on local authorities that all assessors must have the skills, knowledge and competence to carry out the assessment in question. Where an assessor does not have experience in a particular condition (such as autism, learning disabilities, mental health needs or other conditions), they must consult someone with relevant experience. This is so that the person being assessed is involved throughout the process and their needs, outcomes and the impact of needs on their well-being are all accurately identified.”
- So, a social worker carrying out an assessment must have had some training in autism or have consulted someone who does. I find the Council is at fault because it has not been able to provide any evidence that Officer Z or Officer T had any autism training or previous experience of working with adults with autism. There is also no evidence that they consulted anyone in relation to Mr B’s autism. Had they done so, it is possible the outcome of the assessment may have been different. This uncertainty causes Mr B a significant injustice.
Assessment of Mr B’s ability to live independently
- Mr B says the Council has not assessed his ability to live independently.
- Mr B was assessed by Officer R in relation to his ability to live independently whilst on the ward. He was then placed at Park House to continue with the assessment over a three-month period. The support plan sets out details of the assessment. It states the care provider found Mr B could complete some daily living tasks independently or with prompts, for example washing dishes, hoovering, dusting and using the washing machine. He needed support to sort his clothes and bedding ready for washing and ironing but this this level of support could be reduced in time.
- The assessment found Mr B had good knowledge of health and safety in the kitchen. He was able to prepare drinks and snacks independently but needed staff to prompt and support him with planning, preparation and cooking of main meals. He needed support to maintain a healthy well balanced diet otherwise he would tend to eat microwave meals. He also required ongoing support to manage his OCD in relation to the preparation of food. The care provider also noted Mr B would require support and prompts with shopping for food and provisions to ensure appropriate items and amounts were purchased.
- The support plan stated Mr B was fully independent in relation to personal care although staff would need to prompt him to do it.
- I find Mr B’s ability to live independently was assessed over a period of time by the Council and it was satisfied he was able to live independently with some limited support. However, as stated above, Mr B’s assessment and the resulting support plan may have been different if the social workers involved had received autism training or consulted someone with relevant experience. The uncertainty as to whether the outcome may have been different causes Mr B a significant injustice.
Delay in providing an advocate
- Mr B says that the Council delayed in providing a Care Act 2014 advocate for him.
- Mrs C acted as Mr B’s advocate until her death in April 2017.
- During the assessment which took place in June 2017 Mr B was initially supported by a worker from an organisation providing mental health and support services who had known Mr B and his family for 15 years.
- Mr B says that, in late June 2017, he asked Mr D, a friend’s father, to act as his advocate because the Council had not provided a Care Act advocate. Mr D was involved throughout the assessment process and attended most meetings. Mr B was also supported by his solicitor.
- The Council appointed a formal advocate in September 2017. But Mr B says she consistently failed to attend meetings to support him. The Council says it met its duty to provide a Care Act advocate but it became difficult for the advocate because Mr D was also still advocating for Mr B.
- In April 2018 Mr D asked the Council to provide a Care Act advocate to support Mr B at a financial assessment and support his move to the supported living flat. The Council considered this was unnecessary because Mr B’s sister would be present at the financial assessment to represent him. However it did make an advocacy request.
- Under the Care Act, a council is required to appoint an independent advocate to support and represent a person if it considers: he has care and support needs; has substantial difficulty in being involved in the assessment; and there is not an ‘appropriate individual’ to support him. The duty to provide independent advocate does not apply if the council is satisfied there is a person who would be an appropriate person to represent and support the individual for the purpose of facilitating his involvement in the assessment.
- I am satisfied there was no requirement for the Council to appoint a Care Act advocate while Mr B’s mother was supporting him. After her death, Mr B was supported by a support worker who had known him for many years and then by Mr D and his solicitor. He therefore had an appropriate individual to support him and there are no grounds to criticise the Council for failing to appoint an independent advocate.
- In August 2017, in response to the complaint by Mr B’s solicitor, the Council stated that, although he had been receiving support from Mr D and his solicitor, it would provide a Care Act advocate if Mr B wanted one. The Council appointed an advocate in September 2017. I therefore find there was no fault on the Council’s part.
Failure to provide Mr B with support to manage his finances
- Whilst at Park House, the SIS worker worked with Mr B with regard to budgeting, shopping and daily living activities. When Mr B moved to his own flat in February 2018 his new support plan stated he had knowledge and understanding of money and the care provider found he was able to manage his day-to-day finances but found it difficult to manage larger sums of money. The support plan identified Mr B would need ongoing support to manage larger finances, pay bills and budget for larger purchases. The support plan stated the care provider would support Mr B with paperwork and would provide one-to-one support for 30 minutes per week although this would be increased when he first moved to the flat. Staff created a weekly budget planner to assist Mr B.
- The Council initially provided a total of 10 hours support per week including support with finances. The care provider told Mr B’s advocate that it “quickly found that [Mr B] was requiring considerably more than this”. Following a review in March 2018 it asked the Council for funding for an additional eight hours one-to-one support per week. The care provider says “the additional hours were specifically for increased support with his finances and support for community/recreational activities”. The Council agreed to fund an additional three hours per week.
- It is normal for a review to take place a few weeks after a placement begins to assess whether the level of support being provided is adequate or needs to be altered. I am satisfied the Council has provided Mr B with support to manage his finances. But, as previously stated, if his assessment had been carried out by a social worker with experience of autism, it is possible the outcome may have been different and he may have received more support from the outset. There is nothing to say this would definitely have been the case but the uncertainty causes Mr B a significant injustice.
- The Council has agreed that, within one month of the Ombudsman’s final decision, it will:
- apologise to Mr B in writing for failing to complete a carer’s assessment for Mrs C sooner and for the fact that the carer’s assessment completed in December 2016 was not as comprehensive as it should have been;
- review Mr B’s care plan. The review must be undertaken by a suitably trained person or by consulting someone with relevant experience in line with the statutory guidance referred to above; and
- pay Mr B £250 in recognition of its failure to ensure the assessment was carried out in accordance with statutory guidance and the resulting uncertainty about whether the outcome would have been different if this had been done.
- I find the Council was at fault in that:
- it delayed in completing a carer’s assessment for Mr B’s mother and, when the assessment was completed, it was not as comprehensive as it should have been; and
- it has not been able to provide any evidence that officers who assessed Mr B’s needs in late 2017/early 2018 had any autism training or previous experience of working with adults with autism or that they consulted anyone with experience in autism. As a result, Mr B is left with uncertainty about whether, but for this fault, the outcome of the assessment would have been different.
Investigator's decision on behalf of the Ombudsman