Summary: We upheld Ms X’s complaint. There was a delay in assessing her son Mr Y’s social care needs and her need for support in her caring role. There was also a delay in agreeing funding for a day centre placement. The outcome and recommendations of assessments were confusing. The Council will apologise, make payments and review Mr Y’s assessment and care and support plan.

The complaint

1. Ms X complained for herself and for her son Mr Y. She said the Council failed to provide respite care for her or day care for Mr Y. Ms X also complained the Council refused to fund care in a residential care home, having initially recommended this in an assessment.
2. Ms X says her physical and mental health are affected due to dealing with Mr Y’s constant anxiety and she became exhausted when looking after him during a period when she was very unwell.

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The Ombudsman’s role and powers

3. 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)
4. Ms X complained to us in April 2024, so events before April 2023 are late. I have exercised discretion to investigate from October 2022 as she was unwell with cancer and this is a good reason for not complaining to us within 12 months.
5. 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 significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
6. If we are satisfied with an organisation’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

7. I considered the complaint to us, the Council’s response to the complaint and documents set out the next section of this statement. I discussed the complaint with Ms X
8. Ms X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Relevant law and guidance

9. A council must carry out an assessment for any adult with an appearance of need for care and support, applying national criteria to decide if a person is eligible for care. (Care Act 2014, section 9)
10. An assessment should be carried out over a appropriate and reasonable timescale taking into account the urgency of needs. Councils should give the person an indicative timescale and keep them updated. (Care and Support Statutory Guidance 2014, Paragraph 6.24)
11. The Care Act spells out the duty to meet eligible needs (needs which meet the eligibility criteria). (Care Act 2014, section 18)
12. The Care Act explains the different ways a council can meet eligible needs by giving examples of services that may be provided:
1. Accommodation in a care home or other premises
2. Care and support at home
3. Counselling and social work
4. Information, advice and advocacy.

(Care Act 2014, section 8)

13. If a council decides a person is eligible for care, it should prepare a care and support plan which specifies the needs identified in the assessment, says whether and to what extent the needs meet the eligibility criteria and specifies the needs the council is going to meet and how this will be done. The council should give a copy of the care and support plan to the person. (Care Act 2014, sections 24 and 25)
14. A council must carry out a carer’s assessment where it appears a carer may have needs for support. The assessment must include an assessment of the carer’s ability and willingness to continue in the caring role, the outcomes the carer wishes to achieve in daily life and whether support could contribute to achieving those outcomes (Care Act 2014, section 10)
15. The Act makes clear that the local authority is able to meet the carer’s needs by providing a service directly to the adult needing care. In these cases, the carer must still receive a support plan which covers their needs, and how they will be met. (Care and Support Statutory Guidance 2014)

What happened

16. Mr Y is a young adult with autism. He lives with his family. Ms X is his informal carer.

2022

17. Ms X said she requested care and support for Mr Y in October 2022, in particular respite care for him so she could have a break from her caring responsibilities.

2023

18. We asked the Council to provide us with all Care Act assessments for Mr Y. The Council provided us with a ‘reassessment’ dated February 2024 (which I summarise later in paragraph 23). Ms X provided us with an assessment dated February 2023, which the Council did not disclose to us. The Council told us this was because it was a draft and pointed to a section of the form which says “assessment status: being drafted by caseworker.” The Council also told us its system does not retain draft assessments and this is why it had not sent us copy.
19. The outcome of the February 2023 assessment was Mr Y was eligible for care and support. There was a combined carer’s assessment for Ms X on the same assessment form. It noted Ms X had finished treatment for cancer and needed support with respite for Mr Y to allow time for recovery. The outcome of the assessment was Mr Y’s needs were best met in supported living/ residential care. The social worker ticked the ‘no’ box for shared lives. Ms X’s views were noted (she wanted a specific residential care placement for Mr Y.) The form went on to say “primary conclusion: move to residential care (from community).”
20. In May 2023, the social worker completed a form called “Short-term service request form”. The record of the request said:
• Ms X had asked for respite “several months ago”
• A day centre had assessed Mr Y and was waiting for funding.
• The proposal was for three days a week at a council day centre
• The social worker had discussed the funding request with a manager and would “send a short-term intervention for approval.”

The manager noted the following on the paperwork:

“I agree to authorise this short-term service request…. funding agreement will need to be agreed and authorised by Newham's case discussion and funding panel or alternatively through Head of Service. Head of Service is aware that Ms X has been waiting for her son to receive support for a number of months however and Mr Y is in need of an outlet from home in order that his mother is able to continue caring for him informally herself.”

2024

21. Ms X complained to the Council in January 2024 about the matters she has raised with us and about other matters.
22. In January and February, an advocate met with Mr Y to seek his views on his care and support. He was open to moving out of home and expressed various views about living away from his family during the meetings with his advocate, but broadly said he preferred the residential placement which is also Ms X’s preference.
23. A different social worker assessed Mr Y in February 2024. He remained eligible for care and support and Ms X eligible for carers’ support. The assessment summarised their views. The social worker’s recommendation was for a shared lives scheme with carer support and a day centre placement.
24. A manager responded to Ms X’s complaint in February 2024 saying:
• He had “authorised a short-term service request in May 2023, agreeing a proposal for Mr Y to attend a day centre should be discussed and funding pursued.”
• Ms X was correct that funding had not been released for Mr Y to attend the day centre. The records showed Ms X was in contact with Mr Y’s social worker between May and the end of September 2023 about Mr Y’s long-term care and accommodation. However, there was no conclusion reached about funding for the day centre.
• Mr Y was allocated a second social worker in December 2023. The second social worker recommended a shared lives placement as opposed to a residential care placement. This was based on the second social worker’s discussions with Mr Y.
25. The manager did not uphold Ms X’s complaint. Unhappy with the Council’s response, Ms X complained to us at the end of April 2024.
26. The Council’s funding panel approved funding for three days at a day centre for Mr Y in the last week of May 2024. Ms X told me that Mr Y had visited a day centre, but he had not yet started attending.
27. A care and support plan dated June 2024 noted Ms X was no longer able to meet Mr Y’s needs at home due to her own health conditions. She could support Mr Y with meal preparation and shopping. The care and support plan said the Council was commissioning a day centre three days a week. It said carers’ breaks were to be provided as part of the care and support plan. Carers support to be provided was ‘residential respite’. The recommendation for long-term accommodation was a shared lives scheme.
28. Ms X said she has not seen a copy of the February 2024 assessment or the care and support plan referred to in the previous paragraph.

Findings

29. The process of assessing Mr Y’s social care needs and Ms X’s needs as a carer, drawing up care and support plans and putting in place services or funding to meet eligible unmet needs should have been completed in a smooth and timely manner. There is fault because:
• The Council took five months (from October 2022 to February 2023) to carry out a draft assessment. This is not in line with paragraph 6.24 of the Care and Support Statutory Guidance and is unreasonable given Ms X was seeking respite support because of illness;
• Once the ‘draft’ assessment was completed, the Council took no action, despite Mr Y being eligible for care and support and Ms X being eligible for carers’ support. This is not in line with Sections 24 and 25 of the Care Act 2014 which require the Council to draw up a care and support plan and/or carer’s support plan setting out how to meet eligible unmet needs. The care and support plan the Council has disclosed is dated June 2024. This delay of almost 18 months is fault;
• The Council never made a decision to approve the day centre funding request, despite a manager indicating the need for one in May 2023. Funding was not approved until May 2024 by which time Ms X had already complained to us. This delay of a year was fault.
• The variation in recommendations between the two social care assessments is of concern: the draft assessment Ms X provided (dated February 2023) recommends a residential (supported living) placement for Mr Y and a day centre placement. The assessment the Council provided (February 2024) recommended a shared lives placement and a day centre. The conclusion of the assessments is confusing and contradictory and this is fault. There does not appear to have been a change in Mr Y’s needs. We would expect there to be a clear rationale for changing the conclusions and recommendations in social care assessments where there has not been a change in needs.
• Ms X and Mr Y should have received copies of the care and support plan and the later assessment.

Injustice

30. Ms X did not receive the benefit of respite care the Council assessed her as requiring in February 2023. This is a loss of a service to which she had a legal entitlement. It caused avoidable distress at a time when she was seriously unwell.
31. Mr Y was eligible for a day centre placement according to the outcome of the Council’s assessment in February 2023 and the manager’s recommendation for funding for this in May 2023. It has taken a complaint to us for the Council to agree funding in May 2024. And Mr Y is still not attending at the time of writing this statement (September 2024). The Council has a duty to meet Mr Y’s eligible needs. It has not done so. As a result, Mr Y has missed out on three days a week of activities and opportunities to learn new skills and to socialise. This has also prevented Ms Y from having breaks from her caring role.
32. It is not for us to say whether Mr Y requires a placement in residential care or shared lives. This is for the Council. However, we would expect there to be a rational explanation for the different recommendations. There is not one on the evidence available. This is fault causing avoidable confusion and distress.

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Agreed action

33. Within one month of my final decision, the Council will complete the following actions:
1. A review of Mr Y’s social care assessment by a manager with no prior involvement in the case. That manager should have authority to make funding decisions as to whether the Council will fund a residential placement, shared lives placement or another option to meet Mr Y’s eligible needs. The manager should write to Ms X and Mr Y with the outcome of their review.
2. A review of Mr Y’s care and support plan and revisions where necessary to ensure funding is in place to meet eligible needs. This should be completed by the manager in point (a)
3. The Council ensures Mr Y is able to start attending his day centre placement and travel support is in place.
4. A payment of £1000 to Ms X to reflect the distress caused by the failure to provide her with respite care when she was unwell.
5. A payment of £2000 for Mr Y to reflect the loss of opportunities to socialise and gain skills which he would have had if the day centre placement had been available to him.
6. An apology for the injustice caused by the fault identified. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisation should consider this guidance in making the apology I have recommended.
34. The Council should provide us with evidence it has complied with the above actions in paragraph 33.

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Final decision

35. We upheld Ms X’s complaint. There was a delay in assessing her son Mr Y’s social care needs and her need for support in her caring role. There was also a delay in agreeing funding for a day centre placement. The outcome and recommendations of two assessments was confusing. The Council will apologise, make payments and review Mr Y’s assessment and care and support plan.
36. I completed the investigation.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman