Summary: The Council was at fault for poor communication and a failure to properly review Mr X’s care needs after his reablement package ended. It was also at fault for the significant delay in responding to his complaint. The Council has agreed to apologise to Mr X and make a payment to acknowledge the frustration, uncertainty and distress he was caused. It should also offer to reassess his care needs.

The complaint

1. Mr X complained the Council failed to provide him with adequate care and support following a hospital stay. He complained the reablement package did not meet his needs and meant he missed hospital appointments, and the Council ended his reablement care package without offering any further care and support to meet his care needs. It also delayed responding to his complaint. Mr X said this left him frustrated and meant he was without the support he required.

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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 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)
3. We consider whether there was fault in the way an organisation made its decision. If there was no fault in how the organisation made its decision, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
4. When considering complaints we make findings based on the balance of probabilities. This means that we look at the available relevant evidence and decide what was more likely to have happened.
5. 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(1), as amended)

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How I considered this complaint

6. I considered evidence provided by Mr X and the Council as well as relevant law, policy and guidance and our guidance on remedies published on our website.
7. I gave Mr X and the Council an opportunity to comment on a draft of my decision. I considered any comments before making a final decision.

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What I found

Relevant law and guidance

8. Intermediate care and reablement support services are for people usually after they have left hospital or when they are at risk of having to go into hospital. They are time-limited and aim to help a person to preserve or regain the ability to live independently. The National Audit of Intermediate Care lists four types of intermediate care:

• crisis response – services providing short-term care (up to 48 hours);
• home-based intermediate care – services provided to people in their own homes by a team with different specialties but mainly health professionals such as nurses and therapists;
• bed-based intermediate care – services delivered away from home, for example in a community hospital; and
• reablement – services to help people live independently which are provided in the person’s own home by a team of mainly care and support professionals.

9. Regulations require intermediate care and reablement to be provided without charge for up to six weeks. This is for all adults, whether or not they have eligible needs for ongoing care and support. Councils may charge where services are provided beyond the first six weeks but should consider continuing providing them without charge because of the preventive benefits. (Reg 4, Care and Support (Preventing Needs for Care and Support) Regulations 2014).
10. 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. They must provide an assessment to everyone regardless of their finances or whether the council thinks the person 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.
11. Where somebody provides or intends to provide care for another adult and it appears the carer may have any needs for support, the council must carry out a carer’s assessment. A carer’s assessment 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.

The Council’s complaints procedure

12. The Council’s complaints procedure says it aims to respond to complaints within 20 working days.

What happened

13. Mr X lives with his wife and children. Mrs X has her own care needs and receives a package of care which includes support with meal preparation and general household tasks.
14. Following a hospital stay Mr X was discharged home in late July 2024 with a care package of one visit a day in the morning to assist with personal care and to set him up upstairs at home.
15. In early August 2024 the social worker visited Mr X with an NHS therapist. Mr X requested more frequent visits to support him with creaming his legs and to check on him. The social worker advised they could not support with this. They noted:
• the family had recently moved house and there were boxes of unpacked items and there was evidence of cooked meals with pots on the stove.
• the therapist said Mr X was more functionally able and could do his own personal care if required and there were emotional and psychological issues of him feeling unable to cope.
• Mr X displayed anxiety and felt overwhelmed.
16. The social worker reiterated the support was for personal care and was to be reviewed. The social worker spoke to Mrs X about her care package and whether it was meeting her needs. The social worker agreed to refer Mr X for talking therapies and for support with benefits as Mr X was struggling financially.
17. The social worker contacted the care provider that day. It advised Mr X’s mobility was strong, but he still required assistance with personal care. The social worker asked the care worker to ensure visits took place in the morning and that they only assisted with tasks Mr X was unable to do. The social worker messaged Mr X that the support would continue for two weeks with the view to ending the service after review. They said they hoped the goals set by the therapist would be achieved by then.
18. The social worker referred Mr X for talking therapies and for support with his finances. They also referred Mrs X for a review of her care package.
19. Later in August 2024 the social worker contacted the care provider for an update. They also asked the therapist if they had reviewed Mr X. The therapist advised Mr X still needed the morning call for personal care as he was at risk of neglect.
20. Mr X called the social worker around this time to request an additional visit each day to cream his feet. Mr X reported he could not get downstairs due to dizziness. The social worker noted they advised Mr X his wife could take a meal upstairs to him and she received support with preparing meals for the family. They also told Mr X his care workers could not be used to support him to attend appointments. They told Mr X they had referred him for talking therapies and debt support.
21. In late August 2024 Mr X complained to the Council about the amount of support provided and the attitude of the social worker. He also complained he had not received support to attend appointments which the social worker was aware of and he requested an increase in the care package.
22. A Council manager spoke with Mr X. They explained that support was based on an assessment of needs. They told the social worker Mr X agreed to have a joint review with the social worker and therapist. They asked the social worker to consider a joint meeting with the therapist to discuss with him and conclude the matter. The social worker responded that they had visited previously with the therapist and had followed this up in writing. They said the therapist continued to work with Mr X and if the therapist recommended ongoing support with personal care they would progress this.
23. In late August 2024 the social worker again spoke to the care provider. It said they provided a bowl of water and Mr X washed himself. They helped to wash and cream his feet. They got his breakfast and brought it to him.
24. In early September 2024 the therapist visited Mr X. They reported that care workers gave Mr X a strip wash. He said he felt weak and blurry in the morning which restricted him from providing full self-care. He continued to need support with benefits and decluttering. They noted his ‘indoor independence achieved, however partially restricted by cardiovascular and reduced strength particularly during morning calls’. He was advised to continue to exercise and the therapist would continue to practice outdoor mobility with him.
25. The care provider’s records show that for the duration of the care package a care worker supported Mr X with personal care, applying cream and breakfast.
26. The Council decided to end Mr X’s reablement package on 7 September 2024. The social worker called and texted Mr X to advise of this. They also spoke to the therapist who said that Mr X was aware the service was ending.
27. Mr X called the Council on 11 September 2024 as the care workers had not attended and he needed support. He said he had requested a reassessment which had not happened. He requested a reassessment as he said he still needed support.
28. The Council’s safeguarding team considered his request the following day and asked that Mr X be reviewed. It is unclear what happened to this request.
29. A further internal email from the discharge to assess teams to the social work teams in early November 2024 noted Mr X’s reablement ended after six weeks. It said he had since contacted the Council via various means to request a continuous package of care. It asked that the case be allocated initially for a welfare check and subsequently for a needs assessment.
30. The Council allocated Mr X’s case for a review. A social worker contacted Mr X and advised him to contact the Adult Social Care front door team or complete an online self-referral to discuss his care and support needs. They completed a carer’s assessment over the telephone and recommended a one off £300 payment to support Mr X in his caring role for his wife.
31. The Council responded to Mr X’s complaint in late January 2025. It apologised for the delay in responding. It said the social worker’s visit in August 2024 showed Mr X was able to manage his activities of daily living tasks independently and so his support had ended. The social worker agreed to make some referrals and referred Mr X for support with managing debt and psychological therapy and a referral requesting a review of Mrs X’s direct payment. The Council had also recently completed a carer’s assessment which resulted in a payment. It apologised for any distress caused. In response to my enquiries on this complaint the Council said the delay in responding to the complaint was due to staff pressures and migration to a new complaints management system.
32. Mr X remained unhappy and complained to us. He said his health and social care had gone backwards as he was not having washes and was stuck upstairs and the social worker had only visited once.

Findings

33. 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 for establishing a person's needs and if it acted correctly when this process was complete.
34. The social worker visited Mr X with a therapist and considered the reablement support he was receiving of one visit a day was appropriate to meet his needs at that time. They took into account the support Mrs X received and advice from the therapist. They continued to communicate with the care provider and therapist to keep abreast of Mr X’s condition. They also made appropriate referrals for talking therapies, financial advice and to reassess Mrs X’s care and support needs to help support the family. There was no fault in the way the Council reached its decision that one call was sufficient to meet Mr X’s needs or in the support it provided at that time.
35. Mr X was unhappy with the support he was provided and spoke with a Council manager in late August 2024. During their discussion Mr X agreed to a review with the therapist and social worker. Following this, the social worker explained to the manager why they did not consider a visit was necessary. It was for the social worker to decide whether they needed to visit Mr X. However, there is no evidence it was explained directly to Mr X why a further visit was not necessary. This was fault and left Mr X with a sense of frustration and uncertainty as he understood there would be a joint visit and review of his care needs.
36. Mr X requested support with attending appointments. The social worker told Mr X this was not agreed as part of the support plan. However, there is no evidence they explored this further to consider whether Mr X may have had an assessed eligible need for support in this area. This was fault.
37. In early September 2024 the therapist recorded Mr X’s indoor independence was achieved but was partially restricted by his health needs during morning calls. There is no evidence the social worker further explored whether this meant Mr X continued to need support with personal care. This was fault.
38. Mr X contacted the Council to ask for a reassessment. The safeguarding team manager requested his care needs be reviewed in September 2024. This was not progressed. In a further email the discharge to assess team asked its social work teams that Mr X’s needs be reviewed. Again this did not happen. This was fault. The Council reassessed Mr X’s needs as his wife’s carer and provided a small payment. However it told him to complete an online referral or approach the Council’s front door team. Mr X was repeatedly frustrated in his attempts to get his care needs reviewed. This was fault.
39. I cannot say even on balance what might have happened if the Council had reviewed Mr X’s care needs or that Mr X had missed out on support. However the Council’s poor communication and failure to review Mr X’s care and support has left him with a sense of frustration and uncertainty over whether he may have been entitled to more or continued support to meet his needs.
40. The Council did not respond to Mr X’s complaint for nearly five months. This was fault and added to his distress and frustration. In response to my enquiries the Council said the delay was due to staff pressures and a move to a new complaints management system. Following a separate complaint we investigated, the Council reviewed its complaints handling and provided staff training. Given these factors I have not recommended any complaint handling service improvements but we will continue to monitor the Council’s performance through our case work.

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Agreed Action

41. Within one month of the final decision the Council has agreed to:
1. apologise to Mr X and pay him £500 to acknowledge the distress, frustration and uncertainty he was caused by the Council’s poor communication, failure to reassess his needs and delayed complaint response. 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.
2. offer to reassess Mr X’s care needs. If he agrees to a reassessment this should be completed within two months of the date of the final decision.
42. The Council should provide us with evidence it has complied with the above actions.

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Decision

43. I have completed my investigation finding fault causing injustice. The Council has agreed to remedy the injustice caused. The Council has already taken action to improve its complaint handling.

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Investigator's decision on behalf of the Ombudsman