Summary: Miss X complained the Council failed to meet her care needs and charged her client contributions when she was not receiving support. There was no fault in the way the Council sought to find support workers for Miss X or in the way it supported her with repairs. The Council was at fault for not properly considering Miss X’s concerns about her safety in the community. It has already apologised for this. There was no fault in the way it assessed Miss X’s client contribution, but it provided unclear and inaccurate information about what she owed. This was fault. The Council has agreed to apologise and waive Miss X’s debt. It has agreed to ensure it discusses with her how her contribution is paid in future and to review the communication between the relevant teams.

The complaint

1. Miss X complained the Council has failed to support her properly. In particular, it has failed to find her a replacement support worker, did not support her with getting her shower fixed and did not address her concerns about her safety when leaving the house. This has meant her eligible needs are not being met and has caused her distress. In addition, Miss X is unhappy the Council is charging her a contribution towards her care costs when she considers she is not getting the support she needs.

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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. We investigate complaints about councils and certain other bodies. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, section 25(7), as amended)
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. I have considered the information provided by Miss X and by the Council in response to my enquiries. I have considered the relevant law and guidance.
6. I gave Miss X and the Council the opportunity to comment on a draft of this decision. I considered any comments I received in reaching a final decision.

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What I found

7. Sections 9 and 10 of the Care Act 2014 require councils to carry out an assessment for any adult with an appearance of need for care and support. 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.
8. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan (or a support plan for a carer). The support plan must 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.
9. Councils can charge for care services but must do so in line with the relevant law and regulations. When a council decides to charge for care it must carry out a financial assessment. A council must not charge more than the cost it incurs to meet the person’s needs. The amount a person has to pay towards their care and support is called the client contribution.
10. When calculating the client contribution, the Council should allow the person to keep enough benefit to pay for any necessary disability related expenditure (DRE). DRE are specific outgoings related to the individual’s disabilities.

What happened

Background

11. Miss X has a diagnosed social communication disorder. She has difficulty communicating verbally and prefers to communicate by email. She has mental health difficulties and OCD. She is supported by the Council’s Adults and Autism Team (AAT). Miss X lives in a housing association property owned by Cambridge City Council. The following is a summary of key events relevant to the complaint.
12. The Council assessed Miss X’s needs. It assessed Miss X needed support to book and attend appointments, prompting to complete household tasks and personal care during periods of low mental health, support to manage her finances and budgeting and support to access the community, in particular to access local food shops. It found Miss X received informal support from her mother, Ms Y, with managing her finances and with regular food shopping. Her support plan proposed support of six hours per week.
13. Miss X’s support plan also set out that Miss X was aware to contact her GP if she had concerns about her mental health or 111 for immediate concerns.

Care and support and repairs

14. In October 2020 Miss X started to receive one hour of support from a support worker at care provider A. The Council aimed to gradually increase the care package to six hours in line with the support plan as Miss X had previously been reluctant to engage with or accept support.
15. In early October 2020 Miss X emailed her social worker to say she had an issue with her shower. The social worker offered to pass her concerns to her support worker and suggested she contact the City Council as it was responsible for her housing. Miss X also emailed she was worried about going out in the daytime when she might get assaulted as it had happened before when she used to go out. The social worker passed Miss X’s concerns on to her support worker and suggested she discuss the issues at future support sessions.
16. In November 2020 the Council reviewed Miss X’s support plan. The support remained at one hour a week. The support worker was helping with appointments and prompting medication. It was working well and it hoped to gradually increase this. However, the support worker could not offer more hours and Miss X felt unable to engage with other support workers which would enable the hours of support to increase. The social worker advised Miss X the support worker may be able to offer a telephone call each week in addition to their visit if she wished to accept this.
17. Miss X was contacting the social worker regularly, but they were directing her queries to her support worker. The support plan noted Miss X often consented for information to be shared with her mum, Ms Y, but Miss X wanted consent to be sought on each occasion.
18. In December 2020 Ms Y contacted the Council about Miss X’s shower. She said she had arranged a repair with the City Council, but Miss X would not open the door to the repairman. Ms Y asked the City Council to carry out the repair during Miss X’s time with her support worker, but it said it could not guarantee to visit when the support worker was there. The social worker asked the support worker to liaise with the City Council to see if the repair could coincide with their visit.
19. Just before Christmas Miss X emailed her social worker. She said she did not want the support worker to visit again and threatened to harm her if she did. The social worker contacted care provider A. It said Miss X had accused the support worker of laughing at her, but the support worker denied this. Care provider A offered to provide telephone support to Miss X in the meantime as it had no other support workers available at the time.
20. In early January Miss X sent the social worker several short emails over three days that she was unhappy with them and the support worker and that people laughing at her when she went out made her feel in danger. She said she did not go out shopping any more as she was scared because she had trouble since going out. The social worker responded that visits to shops should be minimised anyway due to the COVID-19 restrictions. They recommended Miss X consider continuing to accept support to help with going out. They asked Miss X to confirm if she still wanted care provider A to support her. If not, they would need to complete a formal review.
21. Miss X complained to care provider A and the Council. She said the social worker did not care and did not respond, had not helped her with her broken shower and had ignored her concerns that she was frightened to go out. Miss X told the Council she did not want support workers from care provider A anymore. In early January 2021, the care provider put the care on hold.
22. Miss X emailed that she did not want the current social worker or support worker anymore. She said she was sorry to have made threats but was not sorry to have complained. The social worker ended the care package.
23. The Council responded to the complaint in late January 2021. It found Miss X emailed the social worker frequently and they responded the same day or next, except at the weekend or if they were away from work. It said it was not aware the shower was still broken until Ms Y’s contact of December 2020. At that time, it said the social worker contacted the care provider to ask it to contact the City Council about this. The social worker did not follow this up as they believed it was sorted. It gave Miss X the contact details for repairs at the City Council to contact as she had done previously. It said it was trying to source a new care provider though this may be delayed due to COVID-19 restrictions and asked if she would accept support from the current provider if it could arrange this in the meantime.
24. Regarding Miss X’s concerns for her safety, it said the social worker had suggested Miss X’s support worker could help her with this but it found no evidence they had explored specific incidents or what safeguarding steps could be taken. It said the social worker apologised for not exploring her concerns further at the time. It asked Miss X to provide specific details of any incidents and whether she wished these to be reported to the police or addressed through safeguarding.
25. Following the complaint the Council agreed to change Miss X’s social worker. It reviewed Miss X’s care and support plan, ended the care package and sought a new provider.
26. Miss X contacted the Council in late January to say she had no hot water or heating. The new social worker and a colleague visited Miss X two days later to introduce themselves and update her on finding a new support worker. They explained to Miss X about response times and that the social worker could not always respond straightaway. At the visit a repairman attended and fixed the boiler.
27. Ms Y contacted the Council at the end of January to report Miss X was bullied in the community and had been assaulted on her way to the shops and then ran home. She had reported this to the police. She said the former social worker had ignored Miss X’s concerns. The Council advised Ms Y to report further incidents to the police. The Council also queried whether Miss X’s sibling would consider providing paid care to Miss X under a direct payment arrangement as they were regularly supporting Miss X with appointments, but they declined this.
28. In February 2021 the Council found a new care provider, care provider B, to support Miss X. In March 2021 it introduced the new support worker to Miss X and they started emailing Miss X to build up a relationship.
29. The Council carried out a review of the complaint response in March 2021. It apologised for not addressing her concerns about care provider A in its original complaint response. It said it had spoken to care provider A which said it had given Miss X details of the complaint process after she complained but had not heard from her further. It said it had investigated her concerns but found no evidence to uphold them. It agreed to write to her formally. The Council said it had previously investigated her concerns about her social worker and no further action was necessary.
30. In March 2021 care provider A wrote to Miss X. It said it had spoken to the support worker who said they did not laugh at her. It said it was sorry Miss X felt it did not care. It said in future it would ensure staff were familiar with and would follow the complaints procedure. Around this time, the support worker from care provider B started to provide one hour support per week to Miss X.
31. In April 2021 the support worker started visiting Miss X weekly. Between June and July 2021 there were several weeks Miss X did not receive support due to leave/sickness of the support worker.
32. In July 2021 the social worker reviewed Miss X’s support plan. They found the support worker was visiting weekly, helping organise appointments but the acceptance of the support offered was mixed. The support worker had also visited the vets with Miss X. The support worker reported Miss X did not need any support with personal care and showed no interest in needing assistance in that area. They reported Miss X refused to go into the community at present due to her poor mental health.
33. The social worker noted Miss X found dealing with appointments difficult and she had a high level of anxiety when others visited her home. She needed support when workers visited. They noted Miss X was dealing more with her finances. Ms Y reported Miss X was now doing her own online shopping and would occasionally ask her to buy things for her. They noted Miss X’s mental health was not settled or stable at the time but there had been some progression with her engagement with the support worker. Moving forward they suggested Miss X seek further support from her GP and local mental health services.
34. In early August 2021 Miss X emailed the Council that the support worker had laughed at her, so she had sworn at them. Care provider B contacted the Council to advise it would no longer support Miss X as the risk of allegations and verbal abuse was too high. Miss X also emailed the Council and said she no longer wanted any support.
35. The social worker and a colleague visited Miss X and discussed her concerns. They suggested the option of her having two support workers, but Miss X refused support. The social worker reviewed Miss X’s care and support plan. They recommended ‘double up’ support with two carers to prevent misunderstandings and accusations, starting with one hour a week, to be built up over time.
36. During September 2021 officers from AAT supported Miss X to collect medication and to arrange appointments. They also supported Miss X to attend a medical appointment. In late September 2021 Miss X agreed to having support again.
37. The Council is currently seeking to provide Miss X with 2:1 care. It says it has sought support through its approved providers’ framework and has escalated this to look for providers that are outside of its framework agreement. It says this was hampered by the impact of COVID-19 pandemic. In December a provider stated they may have availability. In the meantime, the AAT team continued supporting Miss X on an ad-hoc basis.

Financial Contribution

38. In 2020 Ms Y complained to the Council about Miss X’s client contributions and that she needed better support to manage her finances. In August 2020, in its complaint response, the Council confirmed Miss X’s contribution at the time was £15.70 per week. It acknowledged its communication could have been better, it had delayed billing her and it waived the outstanding balance.
39. In February 2021 the Council’s finance team advised the AAT that Miss X had a debt of £376.20. The AAT advised there was a waiver applied after Miss X’s complaint. The AAT said Miss X had no care between August and October 2020 so should not be charged for that period and should only be charged for one hour a week for the 11-week period when she had care. It requested a breakdown of the debt, a check to ensure Miss X’s client contributions were correct and that charges should be cancelled for periods when care was not in place. It said that when a new support provider was in place it should look to get a clear system in place for client contributions.
40. In February 2021 Miss X confirmed the Council could contact Ms Y about her client contributions. The Council emailed Ms Y to advise a client contribution debt had accrued. It said the finance team would contact her to discuss repayment.
41. In May 2021 Ms Y told the Council she was giving Miss X more financial responsibility and was getting her to pay her bills.
42. In June 2021 the Council carried out a financial assessment of Miss X. It assessed Miss X should contribute £22 a week to the cost of her care package. Within the assessment it allowed for additional disability related expenditure for taxis so Miss X’s sibling could visit and support her when workmen attended her property and for additional cleaning products due to Miss X’s OCD.
43. In September 2021 the AAT advised the finance team Miss X had not received care for three weeks in June 2021 and two weeks in July 2021. The Council emailed Miss X to confirm credits were applied to her account for periods where she did not receive care.
44. In October 2021 the Council sent Miss X an invoice in error for her client contribution. The Council apologised and confirmed no further action was needed. It said, ‘I am sorry that this has occurred and wish to reassure you that action has been taken to prevent further invoices being sent for [Miss X’s] contribution to her care at this time, whilst we seek an alternative provider’. They noted in the case records Miss X had an outstanding balance of over £300 owed to the Council. There is no evidence the Council advised her of this.
45. In December 2021 the Council sent Miss X a letter entitled ‘letter before action’ which showed she owed £159.76 for outstanding invoices from August, September and October 2021. The Council also sent Miss X a statement of account showing she owed £301.

Findings

Support worker

46. The Council properly assessed Miss X’s care needs and identified she had an eligible need for care and support. The support plan proposed she receive six hours of support per week. The Council has not provided this level of support, as yet, but there is no evidence that was due to Council fault. The evidence shows Miss X found accepting care difficult and she found it difficult to build up a relationship with support workers. The Council sought to introduce the care slowly, with a view to increasing support as the working relationship developed. This was appropriate in the circumstances. The Council identified two care providers but in both cases the care stopped at Miss X’s request, after she raised a concern about the behaviour of the support workers. The support workers denied Miss X’s allegations and I can never establish exactly what happened so will not investigate this further.
47. The Council properly reviewed Miss X’s support plan when the care ceased, and the social worker continued to correspond and assist Miss X as necessary.
48. The evidence shows the Council is actively seeking a new support worker for Miss X. The Council says it sought to identify a new provider through its framework of agreed providers and outside the framework when this was unsuccessful, but it had been unable to source care. In December it identified a potential provider. It should seek to introduce care as soon as possible, subject to Miss X’s agreement.
49. Even if I were to say the delay was fault, I cannot say this caused a significant injustice to Miss X. This is because of the limited level of engagement Miss X has had with the care package. In addition, AAT has continued to provide support when required to meet Miss X’s needs including getting her medication and attending a GP appointment with her.

Shower repairs

50. The responsibility for housing repairs lies with the City Council not the County Council. The Council has sought to assist Miss X through providing her with information about how to access repairs. Miss X has an eligible need for support with appointments and it has sought to meet this need using support workers and by asking the support workers to liaise with the City Council on her behalf.
51. The Council has also included within Miss X’s disability related expenditure an allowance for taxis to enable family members to support her with visits and letting people in. The Council is not at fault.

Accessing the community safely

52. In its complaint response to Miss X the Council acknowledged the social worker did not explore her specific concerns about accessing the community. This is fault. The Council apologised for this which was an appropriate remedy. It asked if she would provide details of any specific incidents which she did not do. Ms Y later shared details of a specific incident which was reported to the police. It is for the police to decide whether to take this matter further and Miss X has not provided any details of other incidents to the Council.

Financial contribution

53. The Council is entitled to charge for care and support. It has calculated Miss X’s client contribution to her care charges in line with the relevant statutory guidance and regulations. It also considered her disability related expenditure. There was no fault in the way it carried out the financial assessment.
54. In response to a previous complaint the Council agreed to waive Ms X’s client contribution up to August 2020. However, the information the Council continued to provide to Miss X and Ms Y about the care charges was confusing and unclear. This was fault. The case notes show the Council made several adjustments to Miss X’s account for periods when care was not provided The Council has provided Miss X with a statement of account which shows dates of invoices and credits but it is not clear how these are related, for what periods Miss X has been charged, which charges were cancelled and whether, given she only received one hour of care per week, she was charged for the actual cost of the care or for her full client contribution. This was fault.
55. Miss X has an eligible need for support with managing her finances. Ms Y does this on an informal basis, but I have seen no evidence the Council discussed with Miss X or Ms Y that Miss X needed to regularly pay her client contributions and how she should go about doing this. This is fault.
56. The Council sent a bill to Miss X in October 2021 when she was not receiving care. This was fault. The Council apologised and told her to ignore this. However, at the time the officer noted Miss X had a debt of £301 and there is no evidence they highlighted this to Miss X or Ms Y.
57. The Council also sent Ms Y a ‘letter before action’ in December 2021 which related to invoices covering periods when Miss X did not receive care. It advised the debt would be referred to debt recovery agents if it was not paid. This was fault. The content of the letter caused Miss X distress.

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Agreed action

58. Within one month of the final decision, the Council has agreed to:
• apologise to Miss X for the distress caused by the unclear and confusing financial information it has provided to her and Ms Y and to waive the £301 debt.
• explain to Miss X, or discuss with Ms Y if Miss X agrees to this, her requirement to pay her client contribution when a support worker is in post and how she intends to pay this.
59. Within two months of my final decision, the Council has agreed to review how the AAT communicates with the finance team to help improve the accuracy of invoices and to ensure these are not sent unnecessarily.

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Final decision

60. I have completed my investigation. There was fault by the Council causing injustice which the Council has agreed to remedy.

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Investigator's decision on behalf of the Ombudsman