Decision : Upheld
Decision date : 24 Aug 2020
The Ombudsman's final decision:
Summary: Mr B complained the Council failed to properly assess his care needs, produce a support plan or make provision to meet his assessed needs. The Council failed to properly communicate what it was doing with the assessment to Mr B and Mrs C and failed to share the assessment and support plan with them. That led to Mrs C having to go to time and trouble to pursue the complaint and left Mr B and Mrs C uncertain about whether Mr B could have received support earlier. Payment to Mr B and Mrs C, action by the Council and reminder to officers is satisfactory remedy.
- The complainant, whom I shall refer to as Mr B, complained the Council:
- failed to tell him a meeting arranged in November 2018 was a social care assessment;
- failed to properly assess his care needs;
- failed to produce a support plan saying how the Council would meet his assessed needs; and
- failed to make provision to meet his assessed needs.
The Ombudsman’s role and powers
- 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)
- 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)
How I considered this complaint
- As part of the investigation, I have:
- considered the complaint and Mr B's comments;
- made enquiries of the Council and considered the comments and documents the Council provided;
- Mr B and the Council now have an opportunity to comment on my draft decision. I will consider their comments before making a final decision.
What I found
The Council’s fact sheets
- The fact sheet on the care act assessment says the assessment is to decide whether a person needs care and support to help them live their day-to-day life. Following the assessment Council will decide whether any of the needs identified are eligible for support.
- The fact sheet on adult social care says once the Council has found out how much help the service user needs and how much time that is likely to take it will produce a provisional personal budget until it completes a support plan. It says the Council will assist the service user to develop their own support plan which will detail how their eligible needs and outcomes will be met. It goes on to say once the service user and their adviser are happy they have completed the proposed support plan the Council will review and approve it. Only then will the Council confirm the final personal budget.
- The fact sheet on the individual service fund makes clear it is where the Council offers a personal budget and the service user agrees to set up an individual service fund to manage some or all of that budget. The fact sheet says the service user can choose which aspects of their budget to manage in this way and the Council will ask them to choose a support provider or care agency who will then manage the personal budget on the service user’s behalf. The fact sheet says the service user will work with the chosen provider or agency to agree how they will use the individual service fund in line with the service user’s support plan. The chosen provider then receives the monthly personal budget payment direct from the Council. The fact sheet says the service user is in control of how to use the fund although it can only be used to fund things detailed in the service users support plan. The fact sheet says at the end of each month the care agency will provide the service user with a monthly statement showing the number of hours of support provided and the amount charged.
Care and Support statutory guidance
- The guidance says care and support should put people in control of their care. Part of this process is the care and support plan. The guidance says the person must be genuinely involved and influential throughout the planning process and should be given every opportunity to take joint ownership of developing the plan with the local authority if they wish, and the local authority agrees. It should be made clear the plan 'belongs' to the person it is intended for, with the local authority role to ensure production and sign-off of the plan to ensure it is suitable to meet the identified needs.
- When developing the plan, there are certain elements that must always be included in the final plan, unless excluded by the Care and Support (Personal Budget Exclusion of Costs) Regulations 2014. These are:
- the needs identified by the assessment;
- whether, and to what extent, the needs meet the eligibility criteria;
- the needs the authority is going to meet, and how it intends to do so;
- for which of the desired outcomes care and support could be relevant;
- the personal budget; and
- information and advice on what can be done to reduce the needs in question, and to prevent or delay the development of needs in the future.
- Mr B has high functioning autism. He has an education, health and care plan. Although the Council carried out an adult social care assessment in previous years Mr B had declined support. The Council carried out a further assessment in September 2018. Following that assessment the Council sought a care provider to at first provide one hour support per week. The Council did not send a copy of the assessment or any support plan to Mr B following completing the assessment.
- The care provider identified by the Council visited Mr B in November 2018 to discuss his needs. The care provider told the Council it could provide a male carer for Mr B. However, the care provider did not put any provision in place and told the Council at the beginning of February 2019 it no longer had a male carer available. The Council therefore amended the number of hours of support to try and attract a new care provider.
- The Council wrote to Mr B’s mother, whom I will refer to as Mrs C, at the beginning of March 2019 to explain one hour support should be provided for Mr B, aiming to increase that over time. The Council explained Mr B’s preference for a male carer with similar interests could present a barrier.
- The Council identified a care provider in June 2019. That care provider began providing support from July 2019. The support provided was only a few hours per week. The care provider stopped providing support at the end of September 2019 as it could not staff the package according to Mr B’s needs and had difficulty finding out what support Mr B needed as he could not direct support. The Council has not yet identified a new care provider. The Council had agreed to work with Mr B to complete a support plan. However, that work is on hold as Mr B does not currently want to pursue support.
- Mrs C says the Council failed to explain a meeting which took place in November 2018 was a social care assessment. Mrs C says the assessment undertaken on that day only concerned Mr B’s request for a few hours support each week from a personal assistant and did not make up a Care Act assessment. The visit Mrs C refers to is a visit from the care provider who had told the Council it could provide the one hour PA support per week Mr B needed. I am therefore satisfied the visit Mrs C is referring to was not a Council visit or a Care Act assessment. However, when the Council responded to Mrs C’s complaint in July 2019 it referred to the care assessment taking place on 26 November 2018. Mrs C may have believed this referred to the visit by the care agency in November 2018. I am satisfied though it was not and the Council’s complaint response made clear the dates it recorded for various assessments for Mr B were not necessarily the date the assessment took place.
- I consider though the Council has worsened Mrs C’s confusion by failing to provide her with information about the assessment process. The evidence I have seen satisfies me the assessment process began at the visit in September 2018. I am concerned though that before that visit the Council did not make clear the purpose of the visit. Rather, when arranging the visit with Mrs C the notes record the Council suggested arranging a visit in response to Mrs C’s concerns about who should be funding Mr B’s travel training. The notes of that telephone call only record the social worker would visit to complete a reassessment to help signpost Mrs C to suitable support services. I do not consider that made clear to Mr B or Mrs C the visit in September 2018 was a care assessment.
- Nor do I consider it would have been clear to Mr B or Mrs C the assessment begun in September 2018 was a care assessment. The assessment completed by the social worker is largely a copy of the information recorded in the 2017 assessment. I recognise it is possible Mr B’s needs have not changed since 2017. However, I would have expected the assessment to explore that if it were the case. However, the assessment does not refer to that. The assessment sets out five areas of eligible need. However, I have seen no evidence to suggest the Council shared that assessment with Mr B or Mrs C on completion. In those circumstances it is unsurprising neither Mr B nor Mrs C understood what provision the Council was seeking to put in place and why. Failure to complete the assessment properly and share it with Mr B and Mrs C is fault. That meant neither Mr B nor Mrs C had the opportunity to question what the social worker recorded in the assessment, particularly about the support worker Mr B required.
- The Council should also have followed up that assessment by completing a support plan and detailing in the support plan the provision to meet the eligible needs in the assessment. In this case the Council completed a brief support plan which did not set out how the provision would meet Mr B’s unmet needs. The Council also did not share that support plan with Mr B or Mrs C. Failure to do that is fault.
- The Council says it deliberately decided not to complete a comprehensive support plan. The Council says due to Mr B’s diagnosis of high functioning autism it must carefully plan any intervention and support. The Council therefore believes the support plan needed to evolve and develop on Mr B’s own terms. I understand the point the Council is making. However, I have seen no evidence to suggest it explained that to Mr B or Mrs C. The Council should develop the support plan with the service user. There is no evidence it did so in this case. Nor is there any documentary evidence detailing the Council’s reasoning for introducing only one hour support at first and increasing that over time, let alone any discussion with Mr B or his Mrs C about that plan. That again is fault. That left Mr B and Mrs C uncertain about what the Council would provide and why.
- The Council says it set up an individual service fund for Mr B. The Council says it did that so Mr B could use the carers in a flexible way, including using accrued care hours all in one day depending on his requirements. I set out in paragraph 7 the individual service fund process. As that says, if an individual service fund is agreed that should include discussion with the service user. It also says the service user will work with the chosen provider or agency to agree how they will use the individual service fund in line with their support plan. Although the Council did not involve Mr B in the only support plan it produced and did not send him a copy, I have seen no evidence to suggest the Council discussed the individual service fund and what that meant with Mr B or Mrs C. That again is fault. It is unsurprising in those circumstances neither Mr B nor Mrs C properly understood what provision was available.
- The Council accepts there was a delay providing one-to-one support. The evidence I have seen satisfies me this was at first because the care provider which said it could provide Mr B with a carer later said it could not do that as it did not have any male carers. I have seen no evidence to suggest the Council knew about that before the beginning of February 2019. I therefore do not criticise it for any failure to put in place support before that point. I am also satisfied the Council quickly readvertised the care package when it became clear the care provider could not provide a carer. I am satisfied the Council properly amended the proposal at that point to include more hours with the aim of attracting more providers. It is clear the Council has had difficulty finding a suitable care provider to take on the package, which is outside the Council’s control. I have seen no evidence though to support Mrs C’s suggestion including too much detail about the type of person Mr B wanted as a PA undermined the Council’s ability to identify a care provider. Rather, the evidence I have seen satisfies me the difficulty related partly to the size of the care package, partly due to Mr B’s remote location and partly due to his request for a male carer.
- I am pleased to note the Council had begun work to draw up a detailed support plan which the Council intended to use to seek a further provider. I consider the Council should have done that earlier when the first provider withdrew. Failure to do that is fault and has potentially delayed Mr B receiving the support identified as necessary. I could not say though that but for the fault Mr B would have received care support earlier as that is still dependent on a care provider having capacity and able to provide a male carer. Nevertheless, I consider Mr B and Mrs C are left not knowing whether the situation would have been different but for the fault identified in this statement.
- Within one month of my decision the Council should:
- apologise to Mr B and Mrs C for not following the assessment process properly;
- pay Mr B £250 to reflect his uncertainty about whether he would have received support earlier but for the faults identified in this statement;
- pay Mrs C £250 to reflect the time and trouble she had to go to pursuing her complaint and her frustration at the lack of support provided to her son; and
- send a memo to the officers involved in carrying out Care Act assessments in this case to remind them of the need to involve the service user and any family members in the assessment, share the completed assessment with the service user and any family members and ensure the service user is involved in drawing up a support plan.
- I have completed my investigation and uphold the complaint.
Investigator's decision on behalf of the Ombudsman