Summary: Ms F complained about the Council’s decisions that she does not have eligible care and support needs and was not eligible for extra care housing. We found no fault.

The complaint

1. Ms F complained about the Council’s decisions that she does not have eligible care and support needs and was not eligible for extra care housing. She says as a result she was left living in unstable temporary accommodation that delayed her therapy, worsened her physical and mental health, and put her at risk of losing her housing.

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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 recommend a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. 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

4. I spoke to Ms F about her complaint and considered the information she sent, the Council’s response to my enquiries and:
• The Care Act 2014
• The Care and Support Statutory Guidance
• The Care and Support (Eligibility Criteria) Regulations 2014
5. Ms F and the Council had an opportunity to comment on my draft decision. I considered any comments before making a final decision.

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What I found

Relevant law and guidance

Care and support assessments

6. The Care Act 2014 requires 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.
7. Councils must carry out assessments over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Councils should tell people when their assessment will take place and keep them informed throughout the assessment.
8. Assessments must involve the individual and where suitable their carer or any other person they might want involved. The local authority must ensure the person can participate effectively, making reasonable adjustments and providing advocacy where required.
9. An assessment must always be appropriate and proportionate. It may come in different formats and can be carried out in various ways, including face-to-face, self-assessments, and online or phone assessments. Assessors must be appropriately trained and have the right skills and knowledge.
10. Under Section 4 of the Care Act 2014, local authorities have a legal duty to provide a universal information and advice service to everyone in their area. The Guidance says councils must ensure information and advice is provided on eligibility and applying for benefits. The care and support needs assessment is an opportunity to provide or signpost such advice. (Care and support statutory guidance, paragraphs 3.24 & 3.25). There is information about accessing independent financial advice and a general benefits advice tool on the Council’s website.

Eligibility for care and support

11. 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 needs must arise from or be related to a physical or mental impairment or illness. And 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.
12. Because of not achieving these outcomes, there is likely to be a significant impact on the adult’s wellbeing.
13. Being “unable to achieve” an outcome includes: needing help to achieve it; experiencing significant pain, distress or anxiety when achieving it; endangering health or safety when achieving it; and taking too long to achieve it.
14. Where local authorities have determined that a person has any eligible needs, they must meet these needs.
15. When a local authority has decided a person is or is not eligible for support it must provide the person with a copy of its decision. If a person disagrees with the decision, they may complain to the council.

Extra Care Housing

16. Extra care housing provides self-contained homes for people needing care and support to live independently. The accommodation is rented and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements.
17. In Hammersmith and Fulham, a person is eligible for extra care housing usually when they are over 55 years old (or have a disability) and have assessed care and support needs that can be met by the extra care provider. In this case, the extra care provider (Provider X) normally requires the person to have had a local authority care and support assessment. A person can be referred to Provider X or can approach them directly to enter into a privately funded arrangement. Most allocations are decided jointly by Provider X and the local authority.

What happened

18. I have summarised the key events.
19. Ms F has mental health needs. Following an illness which caused her to be in hospital for five months, she also had physical health needs. Ms F sold her flat as she was no longer able to afford it. In November 2024, Ms F asked the Council to refer her to Provider X for extra care housing.
20. Ms F’s mental health worker told the Council that Ms F had mobility difficulties, used walking sticks, had problems using the bath and was at risk of falling. The Council called Ms F on 10 December and spoke to her and her support worker. The worker told the Council Ms F was independent with toileting, dressing, meal preparation, medication, laundry, housework and shopping, although these tasks were difficult for her.
21. The Council placed Ms F in temporary accommodation as she was homeless following the sale of her flat. The Council visited Ms F on 17 December to carry out a care and support assessment. Ms F says the assessment was done in the foyer of the hotel she had been placed in.
22. The assessment found that Ms F had physical health problems, poor mobility, a history of falls, difficulty transferring in and out of the bath and from some toilets, and significant mental health difficulties including PTSD, depression and anxiety. Her main concerns were finding suitable accommodation and maintaining her mental wellbeing. However, the assessment concluded that she was able to manage all her daily living activities independently, including personal hygiene, dressing, toileting, preparing meals, accessing the community, and maintaining relationships, although finding suitable accommodation was causing her distress and anxiety.
23. The assessment found that Ms F was able to achieve the outcomes without support, as such she was not eligible for care and support from the Council. The Council therefore did not refer her to Provider X for housing. The housing team would continue to look for suitable accommodation.
24. The Council’s case records say that Ms F’s support worker contacted the Council on 17 January 2025 asking how to challenge this decision. The Council advised Ms F to contact the GP if she had any new medical conditions that may affect the assessment.
25. On 4 July, Ms F sent the Council a completed care and support self-assessment. This said that due to her mental health needs, she found it very difficult to achieve the outcomes without support and prompting. She therefore required daily care and support. The mental health support worker asked for a new care and support assessment to be done. She said Ms F’s mental health needs had not been properly considered in the first assessment and Ms F’s health had deteriorated since losing her flat. She was in pain and had problems with motivation, memory and concentration. The worker said Ms F required help to prevent self-neglect and was only able to have psychotherapy once she was in permanent accommodation.
26. Ms F complained to the Council on 18 July that it had failed to find her suitable supported housing. The Council sent Ms F a care and support assessment referral form. Ms F replied that this was not reasonable as she had already completed two assessments.
27. The Council’s complaint response on 14 August said it had no duty to assess Ms F as she did not appear to have care and support needs. Ms F could contact Provider X directly as it operated its own referral and eligibility criteria.
28. Ms F remained dissatisfied, she said the Council had not assessed her properly and had failed to prevent her housing situation worsening, which was affecting her mental health.
29. The Council’s final response on 11 September said Ms F had been assessed in line with the care and support guidance and Ms F had agreed to the location of the assessment. The Council had not been able to refer Ms F to Provider X as she had not been found to be eligible for support but it had explored appropriate housing options. The Council said if Ms F wished to be assessed by the NHS mental health team for further support, she should contact her GP.
30. After Ms F came to the Ombudsman, she applied for and was awarded Attendance Allowance. She then contacted Provider X directly and was offered accommodation there. Ms F says she does not have a council care and support package but Provider X’s core provision for private residents, which includes a morning telephone welfare call rather than a scheduled personal care visit. She can use the alarm system, but any response may in some circumstances be chargeable as she is a private resident.

My 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. My 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. In doing this, we look at what information the Council considered, and if it took account of the service user’s wishes. If the Council has considered all this information properly, I cannot find it at fault just because a service user disagrees with its decision, or outcome of an assessment.
32. I have considered the care and support assessment completed in December 2024. The assessment identified Ms F’s needs and concluded that Ms F was able to achieve all of the relevant outcomes independently. As a result, it found that she did not have eligible care and support needs and was therefore not entitled to support from the Council under the Care Act.
33. I have carefully considered the location of the assessment, which Ms F says was inappropriate. Councils must ensure people are able to participate in their assessments but there are no restrictions on the locations. Whilst I understand why Ms F felt the hotel lobby was not appropriate, the Council considered her views and involved her in the assessment. It also spoke to her mental health support worker and was aware of her needs. I find the Council carried out the assessment in line with the Guidance. I therefore do not find fault in the way the assessment was done.
34. I appreciate Ms F considers the Council failed to properly consider her mental health needs. But I cannot question the Council's decision just because a person disagrees with it. As I have found no fault in the process, I am unable to question the decision that Ms F did not have eligible care and support needs.
35. The Council was entitled to decide in July 2025 that there had been no change in Ms F’s circumstances that required a new assessment. I do not find fault.
36. Ms F later found that she was eligible for Attendance Allowance benefit. I have considered whether the Council should have advised Ms F to apply for Attendance Allowance. The Council signposts benefits advice on its website so I do not find there was any fault by the Council.

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Decision

37. There was no fault by the Council. I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman