Summary: Mr X complained the Council stopped his care package leaving him without care and support. There was no fault in the way the Council assessed Mr X’s care needs and decided he did not meet the criteria for formal care and support.

The complaint

1. Mr X complained the Council stopped his home care package in October 2018, leaving him without the care and support he needed. He says this affected his health and wellbeing, causing him distress.
2. Mr X wants the Council to reassess his needs, backdate his personal budget, apologise and make sure staff are trained to carry out Care Act compliant assessments.

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The Ombudsman’s role and powers

3. 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)
4. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. (Local Government Act 1974, sections 26B and 34D, as amended) Mr X’s care package stopped in December 2016. Mr X’s representative complained to us in October 2019. I have exercised my discretion to consider the Councils actions from February 2018 onwards when it allocated a social worker to reassess Mr X’s needs.
5. 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

6. I have considered the information supplied by Mr X’s representative. I have considered the Council’s response to our enquiries and the relevant law and guidance.
7. I gave Mr X’s representative and the Council the opportunity to comment on a draft of this decision. I considered the comments I received before reaching a final decision.

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What I found

8. 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.
9. The Guidance sets out that ‘the assessment process also provides the opportunity for local authorities to take a holistic view of the person’s needs in the context of their wider support network. Local authorities must consider how the adult, their support network and the wider community can contribute towards meeting the outcomes the person wants to achieve’.
10. It sets out that in carrying out a proportionate assessment, local authorities must have regard to;
• the person’s wishes and preferences and desired outcomes;
• the severity and extent of the person’s need;
• the potential fluctuation of a person’s needs. For example, where the local authority is aware that an adult’s needs fluctuate over time, the assessment carried out at a particular moment may take into account the adult’s history to get a complete picture of the person’s needs.
11. The Care and Support (Eligibility Criteria) Regulations 2014 set 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:
• The needs must arise from or be related to a physical or mental impairment or illness.
• 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.
• Because of not achieving these outcomes, there is likely to be a significant impact on the adult’s well-being.
12. Where local authorities have determined that a person has 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.

What happened

13. Mr X has chronic fatigue syndrome. Mr X previously received a care and support package from the Council which ended in December 2016. Mr X had previously lived in his own flat. He moved in with his mother due to the poor condition of his property. In February 2018, the Council allocated Mr X’s case to a social worker to carry out a needs’ assessment.
14. In March 2018, the social worker requested Mr X’s permission to speak with his GP about his physical health needs and medical condition. Mr X agreed to this and the social worker spoke on the phone to the GP who agreed to provide further information by email.
15. The social worker visited Mr X in April 2018. Mr X’s mother and sibling were also present. The social worker proposed using the Council’s reablement team to provide care initially. Mr X requested support with domestic tasks, meal preparation, shopping and some elements of personal care.
16. Mr X’s GP contacted the social worker in May 2018 by email to say Mr X did not want the GP speaking to the Council prior to the assessment.
17. In June 2018 Mr X’s case was allocated to a different social worker. They visited Mr X and he gave consent for the social worker to contact the GP. They spoke to the GP by telephone. The social worker noted the GP said they did ‘not doubt that [Mr X] had physical health problems and that he might need social care support but it is difficult to gauge how much his physical health is disabling him to carry out activities of daily living because of his complex personality’.
18. In August 2018, the social worker visited Mr X and confirmed the reablement team would work with Mr X as part of the assessment process.
19. In September 2018, the reablement team visited Mr X for a week. They reported it was difficult to get clarity around Mr X’s care needs and Mr X did not fully engage with the process. They reported he was very animated and could show them round but when questioned about his condition he displayed symptoms.
20. The social worker visited Mr X in October 2018 to assess his needs. They noted it was difficult to get an understanding of Mr X’s needs. They noted Mr X engaged at the assessment without communication difficulties or signs of tiredness. They noted Mr X had previously had his flat cleaned by social services due to hoarding tendencies and had declined input from mental health services. Mr X was currently living with his mother who helped with cleaning. The assessment noted reablement could not establish Mr X’s needs regarding shopping and preparing meals. He had said he needed special cooked foods but had also previously stated he was eating takeaways. They noted Mr X had been seen mobilising in the community but that he may require support with shopping on occasions due to the variability of his symptoms but was unwilling to accept the support and resources made available or suggested to him.
21. They noted Mr X had no needs relating to personal care or continence care and had little or no difficulty with mobilising. Mr X reported he had a wheelchair for outdoor use when he got tired but was able to transfer and mobilise round the house at the time of the assessment. The social worker noted it was difficult to get information regarding social relationships although previously Mr X requested assistance to take him shopping and to go out. The social worker explained transport options available to Mr X. They noted Mr X said he could only use a car provided by support workers, but they had witnessed him walk into the building having been out in the community. They noted no needs in relation to work, training or education, staying safe or in relation to caring for others. They noted Mr X was able to plan and make decisions but was fixated with his past dealings with social care. They noted Mr X did not disclose he was on regular medication but said he was in regular pain.
22. They noted Mr X refused to disclose information about his current GP and would not allow social services to contact any health services for information in support of the review. The assessment concluded Mr X had needs in relation to maintaining his home in a sufficiently clean and safe condition. As it only identified a need in one domain he did not meet the threshold for care and support. The Council suggested Mr X contact his GP for support to manage his condition and his hoarding behaviour.

Mr X’s complaint to the Council

23. Mr X complained in January 2019. The Council replied in February to say:
• Its professional judgement was that Mr X needed to get help from mental health services. He had not given permission for the Council to contact mental health services.
• Over time, previous care providers had stopped their care for Mr X after he made allegations and asked carers to do things that were not part of the care package.
• A social worker had assessed Mr X in October 2018, deciding he did not meet the threshold for social care. The social worker had considered evidence from Mr X’s GP. Mr X had not agreed to be referred to mental health services.
• It offered to clean Mr X’s home and asked him to choose a cleaner to do so. He had not replied to this and the Council suggested he or his advocate should contact the Council to discuss his housing situation.
24. The Council referred Mr X to the Ombudsman. Mr X’s representative continued to complain on his behalf, asking whether the Council’s decision to end care was because Mr X now lived with his mother. It said:
• Its decision was not influenced by Mr X living with his mother who worked and so did not provide him with much support.
• Mr X’s GP said he had a physical health condition and might also have a mental health problem. The Council had therefore encouraged Mr X to contact mental health services. He had refused.
25. Mr X’s new GP wrote to the Council in June 2019 saying his health condition affected all aspects of his life. The letter said Mr X had told the GP he needed a carer to prepare meals, do housework and maintain his home and that carers had supported him in the past but now stopped. His mother could not care for him as she was unwell. The GP asked the Council to carry out a home visit to assess Mr X’s care needs.

Reassessment

26. In July 2019, the Council agreed to reassess Mr X’s care needs. A social worker visited Mr X on two occasions in July 2019 to carry out the assessment. Mr X’s mother was also involved. Mr X declined consent for the Council to liaise with his GP. However, they considered information Mr X provided including a letter from his GP from September 2017, the recent GP’s letter and other letters from medical professionals Mr X had supplied.
27. The GP’s letter from September 2017 explained that Mr X’s medical condition affected all aspects of his life including meal preparation, phone calls, personal care and socialising.
28. The GP’s letter set out Mr X’s situation in detail. It referred to particular tasks Mr X needed help with. It set out the GP’s opinion Mr X needed a carer to help with essential daily tasks and getting out and about. It explained the impact not having a carer was having on Mr X’s wellbeing, including the poor condition of his home, his mental and physical health.
29. In the assessment the social worker noted Mr X had good communication and analytical skills. Mr X gave full responses and there were some contradictions between how Mr X described his needs and how he presented. They noted Mr X remained living with his mother and the Council had now repossessed his flat.
30. They noted:
• Mr X had arranged a deep clean of his mother’s property due to clutter. He was offered a referral to mental health services to support him with his needs regarding hoarding but he refused. They noted Mr X appeared to lack motivation to engage in cleaning/tidying up but declined a referral for help with building his motivation.
• Mr X’s sibling supported him with on-line shopping but did not wish to continue with this. Mr X said he bought take-aways and went out occasionally to the local shops or post office but tired quickly. They suggested Mr X use some of his Personal Independence Payment benefits to hire a personal shopper to take his shopping list and complete the shopping tasks for him or to use a taxi to and from shopping trips. Mr X disagreed and considered his needs could only be met by formal carers.
• Mr X was physically able to manage microwaving a meal but was concerned he would give up or tire easily and buy a takeaway. They noted Mr X was active and focused during the assessment and able to respond to the doorbell during the assessment. The social worker noted they felt Mr X’s difficulties were more psychological with low motivation on his part with an unrealistic expectation about the role of social services.
• Mr X was well groomed with no needs related to personal care. They noted Mr X could move freely and ably round his house without difficulty. They noted he used a walking stick to safely access the community. They noted Mr X had good insight into his needs and could anticipate and prevent risks to his safety and wellbeing in the community. They advised him to use a taxi for longer journeys.
• Mr X reported he had physical pain but would not engage with his GP to address this. Mr X did not provide evidence of any prescribed medication but took over the counter medication for pain relief.
• They noted Mr X had needs in relation to maintaining his home but as he did not have eligible needs in two domains he was not eligible for formal care and support. They advised Mr X to contact his GP about pain management and recommended he engage with mental health services for support with mental distress and lack of motivation.

Findings

31. It is not the Ombudsman’s role to decide what, if any, care and support a person needs. That is the Council’s role. The Ombudsman’s role is to consider if the Council has followed the correct process in assessing a person’s needs. Mr X and his family participated in the assessments in October 2018 and July 2019.
32. The October 2018 assessment considered information from speaking to Mr X’s GP, from a home visit and from the input of the reablement team. It took into account Mr X’s fluctuating needs but concluded he did not meet the eligibility criteria. Mr X says the Council failed to take into account previous medical letters. Even if I were to say this was fault the Council took this information into account when it reassessed Mr X’s needs in July 2019. Therefore, there is no good reason to investigate this further.
33. Mr X did not consent to the Council contacting the GP for up to date medical information to inform the July 2019 assessment. However, the Council considered the information it had received from speaking to Mr X’s GP and the medical information Mr X provided. The assessment considered available and relevant information and did not consider irrelevant matters. The social worker’s findings were supported by their observations. It Council found eligible needs in one domain but that was not sufficient to meet the criteria for Council funded support. The Council explained the reasons for its decision. Mr X disagrees with the assessment but there is no fault in the way the Council assessed Mr X’s needs.
34. When Mr X contacted the Council again in July 2019 it carried out a reassessment. The evidence shows the social worker met with Mr X on two occasions and discussed his needs in some depth. They remained of the view Mr X did not have eligible needs for care and support. There is no evidence of fault in the Council’s actions. The Council suggested ways Mr X could get support through his GP or mental health services. Mr X considers a care package is the only way to meet his needs. As there was no fault in the way the Council assessed Mr X’s needs I cannot question the decision.

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Final decision

35. I have completed my investigation as there is no evidence of fault by the Council.

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Investigator's decision on behalf of the Ombudsman