Summary: Mrs X complained the Council failed to meet her adult son’s care needs and her needs as a carer. There is no fault by the Council.

The complaint

1. Mrs X complained the Council has failed to meet her adult son, Mr Y’s, needs for care and support leaving him without adequate support. It has also failed to meet her needs as his carer, causing her significant carer’s strain.

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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 provided by Mrs X and I discussed the complaint with her on the telephone. I have considered the Council’s response to my enquiries.
5. I gave Mrs X and the Council the opportunity to comment on a draft of this decision. I considered their comments before I reached a final decision.

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What I found

6. 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.
7. 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:
1. Managing and maintaining nutrition;
2. Maintaining personal hygiene;
3. Managing toilet needs;
4. Being appropriately clothed;
5. Being able to make use of the adult’s home safely;
6. Maintaining a habitable home environment;
7. Developing and maintaining family or other personal relationships;
8. Accessing and engaging in work, training, education or volunteering;
9. Making use of necessary facilities or services in the local community including public transport, and recreational facilities or services; and
10. 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.
8. 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.
9. The Autism Act 2009 required the government to publish an autism strategy and to periodically review it. Think Autism 2014, the most recent autism strategy, sets out that local authorities should:
• make basic autism training available for all staff working in health and social care;
• develop or provide specialist training for those in roles that have a direct impact on access to services for adults with autism; and
• include quality autism awareness training within general equality and diversity training programmes across public services.

The Care and Support Statutory Guidance sets out that “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 wellbeing are all accurately identified.”

What happened

10. Mr Y is a young adult with learning difficulties and communication difficulties associated with autism.
11. In February/March 2018 the Council reviewed Mr Y’s care needs. The review identified Mrs X provided significant support to Mr Y and that Mr Y had eligible needs in relation to accessing and engaging in education, making use of necessary facilities and services in the local community, developing and maintaining personal relationships, maintaining personal hygiene and managing and maintaining nutrition.
12. It noted Mrs X required support with meeting Mr Y’s personal care needs. He was uncooperative with Mrs X and the Council was looking to identify appropriate support for Mr Y every morning. It noted Mr Y attended a day centre on two days per week with background support and some 1:1 support available at the centre. The review noted Mr Y could attend on more days if it met his needs. Mrs X also requested respite as she needed a break from supporting Mr Y.
13. In April 2018 Mr Y started to receive one hour of care per morning to meet his assessed needs relating to maintaining personal hygiene and maintaining and managing nutrition. Mrs X says this is delivered five days a week and lasts no more than half an hour. A care provider also agreed to assess Mr Y for 28 days of respite care per year. It arranged to meet Mrs X and Mr Y. However, Mrs X later told the Council Mr Y did not wish to attend.
14. The Council arranged for a social worker (social worker A) and potential respite provider to meet with Mrs X in September 2018. Also present was a representative Mrs X employs privately as an autism consultant. Mrs X says the respite provider was unable to answer her representative’s questions and the provider raised their voice. She says social worker A was unable to control the meeting and had little knowledge of autism. Mrs X complained to the Council about this in early October 2018.
15. The Council responded to Mrs X’s complaint in early November 2018. It noted she had raised her concerns over the phone in September 2018 and had confirmed at the time she was willing to continue working with social worker A. It said it had raised her concerns about the care provider with its quality team. It said social worker A had autism training and access to specialist heath colleagues. It was sorry they had not taken control of the meeting. It said social worker A had approached their manager and had a debrief to reflect on the meeting. They had also been offered training in managing challenging situations. Mrs X remained dissatisfied. Her consultant considered social worker A did not have the correct knowledge to deal with Mr Y’s case. In line with her consultant’s recommendations Mrs X wanted a social worker with at least 5 years’ experience.
16. The Council responded in late November 2018. It had reallocated the case to social worker B who had contacted the lead for autism practice at the NHS Foundation Trust. They agreed to accompany social worker B when they met Mrs X.
17. Mrs X remained unhappy and asked why social worker A had not provided their certificate of autism awareness. From now on she wanted a social worker to have a continuous professional development (CPD) certified certificate of autism training with a minimum number of hours continuous professional development time to date with her son’s case.
18. Social worker B arranged to meet with Mrs X in January 2019. Mrs X was unhappy social worker B did not share their certificate of autism training. Following the meeting she continued to raise concerns about what had happened in September 2018 and wrote to the Council to complain.
19. In February 2019 the social worker amended Mr Y’s care plan, increasing his day centre attendance from two days to four. They also included two nights respite per month. They also referred Mrs X for a carer’s assessment
20. An officer from the Council’s complaints team rang Mrs X in February 2019 to discuss her complaints. Mrs X complained social worker B had not shared their autism certificate with her. She said social worker B had taken away some questions posed by her autism consultant but had not responded to them. Mrs X said she did not want social worker B involved until they provided evidence of their training certificates.
21. The complaints officer arranged to meet with Mrs X in March 2019, along with a council manager, to discuss her concerns. Prior to the meeting Mrs X emailed the complaints officer that she required to see their certificates of autism training before the meeting or it would not go ahead. The complaints officer offered to email social worker B’s certificates to Mrs X and explained it was best practice to offer to meet to go through Mrs X’s concerns. The purpose of the meeting was to go through her concerns and discuss a way of moving forward so Adult Social Care could work effectively with Mr Y. Mrs X cancelled the meeting because she was not satisfied with social worker’s B’s experience and training in dealing with autism.
22. In late March 2019 Mrs X emailed the Council that her consultant considered the Council’s in-house training in autism was not sufficient. She said she did not want a newly qualified social worker or manager who did not have experience with autism. She asked that her consultant’s questions be answered and that relevant accredited training certificates be provided for all those dealing with the case.
23. In April 2019 Mr Y’s attendance at day care increased from two days a week to four days a week.
24. The Council sent Mrs X a formal complaint response in May 2019. This set out that the Council was satisfied with social worker B’s understanding of autism and with their continued professional development in this area. It was satisfied they had the necessary skills and competence to undertake their duties under Care Act. It set out that the statutory guidance did not set out the need for a specific academic qualification or for five years’ experience. It said it had responded to her consultant in October 2018 and he was given advice on how to appeal at that time if he was not happy with the response given. Regarding the September 2018 meeting, it said it had already sent her a clear outline of the actions it had taken which included apologising. It said it welcomed a meeting to look at how to move things forward and asked Mrs X to contact the Council to rearrange a meeting to discuss any concerns.
25. Mrs X remained unhappy and questioned social worker B’s knowledge of autism. Mrs X did not want a meeting without seeing relevant certificates of anyone involved in her son’s case. She said until this was sorted she wanted nothing more to do with social services and would continue as she has done previously. Mrs X’s consultant also contacted the Council setting out his recommendation for the skills and experience required by social workers working with Mr Y and that until this was resolved no more meetings would happen.
26. In late May 2019 the day centre spoke to Mrs X. Mr Y’s behaviours were escalating and it suggested reducing the day care back to two days a week. It says Mrs X agreed to this. Mrs X later texted the day centre manager to say she had withdrawn Mr Y from the day centre. The Council spoke to Mrs X who felt if the day centre could not cope with Mr Y on four days it could not cope on two and so he should not attend. She agreed the Council could look for another provider.
27. Mrs X would not work with one provider the Council contacted. Two providers told the Council they were unable to progress the referral due to Mrs X’s requirements regarding the level of qualifications held by staff. Mr Y is currently not attending any day centre provision although the Council says the previous provider remains an option if Mr Y wishes to accept it.

Findings

28. The Council assessed Mr Y’s needs. It identified eligible needs for accessing and engaging in education, making use of the necessary facilities and services in the local community and developing and maintaining personal relationships. But these needs are not being met. However, this is not as a result of fault by the Council. Mr Y was attending a day centre. The day centre had difficulties managing Mr Y’s behaviour when his attendance increased to four days and suggested it reduce attendance to two. There is no evidence it refused to meet Mr Y’s needs. It was Mrs X’s choice to withdraw him from this. The Council has identified potential alternative providers but Mrs X has not progressed these as they do not meet her criteria regarding staff qualifications.
29. The Council identified Mrs X needed support as a carer and agreed to provide respite for Mr Y. However, Mrs X has not engaged with the Council in identifying a suitable respite provider.
30. The Council accepted, when a provider visited Mrs X in September 2018, social worker A failed to control the meeting. The Council has already apologised for this. It also said social worker A held a debrief with their manager and was offered training following this. An apology was an appropriate remedy for any injustice caused to Mrs X at the meeting and there is nothing else I could achieve by investigating this incident further.
31. The autism strategy, and Care and Support Statutory Guidance, emphasise the importance of council officers having specialist training in autism and for those carrying out assessments to have the necessary skills and competence. This is to ensure they understand autism and can properly assess the care needs of those with autism.
32. Mrs X and her autism consultant have set out their requirements for the level of training and experience required by council officers before they can deal with Mr Y’s case. The autism strategy and Care and Support Statutory Guidance do not require council officers to be specialists in autism but to have had specialist training. There is no requirement for a particular qualification, or that training cannot be delivered in-house or for it to be ‘accredited’ or at a particular level. The Council provides in-house training to staff but that does not mean it is inappropriate or irrelevant. There is no legal requirement for staff to have a level 3 qualification. The Council is not at fault.
33. The Council is satisfied social worker B has the appropriate skills, experience and training to work with Mr Y. Social worker B also took an autism lead from the NHS Trust with them to meetings with Mr Y and Mrs X for advice and assistance. The Council is not at fault for allocating social worker B to Mr Y’s case.
34. The Council has arranged meetings which Mrs X will not attend as she is not satisfied with the evidence the Council has provided of autism qualifications. There is no legal requirement for officers to produce such certificates before meetings so the Council is not at fault for this.
35. Mr Y has unmet needs and the Council has a duty to meet these. The Council is responsible for ensuring care and support is provided to Mr Y in line with his best interests. The Council proposes meeting with Mrs X to discuss her remaining issues. It has also proposed referring Mr Y to an independent advocate to ensure that his interests are being considered and represented.
36. The Council has also proposed undertaking a review of Mr Y’s care needs. This will include an assessment of capacity under the Mental Capacity Act 2005 to determine whether he lacks capacity to make arrangements about his care and support needs. This is appropriate.

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Final decision

37. I have completed my investigation. There is no evidence of fault by the Council.

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Investigator's decision on behalf of the Ombudsman