Summary: Ms X complained the Council failed to properly assess her need for care or meet her needs. Ms X also complained the Council delayed referring her homelessness application to other local authorities. The Council was not at fault regarding referring her homelessness application to other authorities. It was at fault for reducing Ms X’s care package without reviewing her care plan and delay in allocating her a social worker. This caused Ms X avoidable distress. The Council will apologise and remind its staff they must carry out a review before reducing someone’s care package.

The complaint

1. Ms X complained the Council failed to properly assess her need for care or meet her needs. Ms X also complained the Council delayed referring her case to other local authorities when she was potentially threatened with homelessness. Ms X says this was distressing and isolating and has affected her health.

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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 cannot question whether a council’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), as amended)
4. The law says we cannot normally investigate a complaint unless we are satisfied the Council knows about the complaint and has had an opportunity to investigate and reply. However, we may decide to investigate if we consider it would be unreasonable to notify the Council of the complaint and give it an opportunity to investigate and reply (Local Government Act 1974, section 26(5)).
5. Ms X complained the Care Provider (All Care) did not visit at the time specified in her care plan. I have exercised discretion to look at the issue because it is closely linked to the rest of Ms X’s complaint.
6. 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)
7. 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

8. I have considered:
• all the information Ms X provided and discussed the complaint with her;
• the Council’s comments about the complaint and the supporting documents it provided; and
• relevant law and guidance and the Ombudsman's guidance on remedies.
9. 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

Needs assessments and care planning

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. This is a needs assessment. 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.
11. The Care and Support Statutory Guidance (the Guidance) says that an assessment should be carried out over an appropriate and reasonable timescale, taking into account the urgency of needs and considering any fluctuation in them. We expect councils should complete assessments in a timescale that is proportionate to the complexity of the issues, and normally within 28 calendar days.
12. If the person has eligible needs and has capital below £23,250 the council must meet their needs. To do this, it must produce a care and support plan. The care and support plan should consider what needs the person has, what they want to achieve, what they can do by themselves or with existing support and what care and support may be available in the local area.  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. The support the council offers can vary significantly. Options include:
• visits at home from carers;
• equipment such as bath benches; and
• putting the person in contact with charities.
13. Section 27 of the Care Act 2014 says councils should keep care and support plans under review. The Guidance says councils should review plans at least every 12 months. Councils must also conduct a review if an adult or a person acting on the adult’s behalf makes a reasonable request for one. If there is information which suggests the person’s plan is no longer appropriate, the council should immediately review the plan to see if it needs revision. The person should be fully involved in the review.

Disabled Facilities Grants

14. Disabled Facilities Grants (DFGs) are for people with a qualifying disability who need adaptations to their home to help them stay living there. Before awarding a DFG, the council carries out an assessment. The assessment is usually completed by an occupational therapist. 
15. The Housing Grants, Construction and Regeneration Act 1996 sets out what a DFG can be used for. It includes enabling access to and from their dwelling. It does not include movement of utility boxes to allow the person to make top up payments.
16. Ms X lives in an area with two tiers of local government. Hampshire County Council (the Council) is responsible for adult social care. Its role is to assess Ms X’s needs and determine what adaptations she might need. Another council, Council B, is responsible for administering housing, including carrying out the Disabled Facilities Grants.

Duty to refer

17. Someone is threatened with homelessness if, when asking for assistance from the Council they are likely to become homeless within 56 days or they have been served with a valid Section 21 notice which will expire within 56 days.
18. The Homelessness Reduction Act 2017 placed a duty on certain bodies, including social services, to refer people who they think may be homeless or threatened with homelessness to council housing teams. There is no statutory timescale for the referral but we would expect the body to act without undue delay.

What happened

19. This section sets out the key events in this case and is not intended to be a detailed chronology.
20. Miss X has complex needs including difficulties with her mobility and mental health. Miss X lives in a property managed by a housing association. There are stairs to leave the property, which Miss X says she cannot use due to her pain. The property is located away from her support network and in the time complained about, Miss X told the Council she did not want to live in its area anymore.
21. In March 2020, Ms X contacted the Council about her mental health. In late March, a member of the Council's mental health team called Ms X and carried out a telephone needs assessment. It decided Ms X was eligible for care and support.
22. The Council produced a care and support plan which noted the Council referred Ms X to several services including its Occupational Therapy (OT) department, the community mental health team and a local charity to help her access the community. It also offered her a referral to a falls alarm service. Ms X says the Council did not send her the outcome of its assessment or care plan. The Council told me it expects the allocated worker to send the outcomes of needs assessments and care plans but it has no evidence it sent the files to Ms X.
23. Ms X initially refused to accept support from the OT due to concerns about the COVID-19 virus but in early June, agreed. Ms X spoke to the OT that month, who recommended some equipment including a bath stool and a perching stool for the kitchen. Ms X told the OT she was waiting for someone to check her boiler was safe before her gas could be turned back on. In the meantime, she did not have any hot water. The Council spoke to Ms X and confirmed she would speak to her energy provider.
24. The Council considered Ms X’s physical needs were increasing and decided she might benefit from help from its physical disabilities team. In late June 2020, the team carried out a further needs assessment and decided Ms X needed help from carers. The assessment noted someone from the local charity has been visiting Ms X and helping her take out the rubbish every week.
25. Ms X’s care and support plan noted she would receive five and a half hours of support from carers every week to help her wash, clean, tidy, manage her money, do her shopping and “other tasks she may want support with”’. It said the Council would talk to Ms X about the falls alarm service again because she had not accepted the referral due to concerns about COVID-19.
26. From July 2020 onwards, a home care provider, All Care, began fulfilling Ms X’s care package. However, Ms X soon began refusing to allow carers into her property. Ms X told me this was because carers came without wearing appropriate Personal Protective Equipment (PPE) or removed it mid-visit, she had a bad cold and was worried about the risk posed by the COVID-19 virus.
27. In late September, All Care told the Council it wanted to cancel the care package because she was not allowing carers into her home; they were only taking her rubbish out and collecting her prescriptions if needed. The Council decided to reduce Ms X’s care package to two half an hour visits per week to act as a welfare check.
28. When All Care told Ms X the Council had reduced her care package, she requested a review of her needs. The Council carried out a needs assessment in mid-November 2020. The assessment noted “we discussed the idea of [Ms X] attending groups if she was supported with the stairs”. It did not change her care package because Ms X was still refusing to allow the care workers to provide support.
29. In late 2020 Ms X contacted the Council several times to complain about her care. In summary she said:
• her utility meters were downstairs so she could not top them up. As a result, she was without hot water. Carers had previously been carrying kettles through the flat to give her a bath but they were no longer allowed to do that. She was now only able to have a wash using wipes;
• she was unhappy her care package was reduced to one hour; and
• she had recently fallen and hurt herself. She was concerned she did not have a falls alarm.
30. In December 2020, the Council responded to Ms X to say it would allocate her case to a social worker to carry out a review of her care package and check if she was eligible for any additional support or services.
31. In late March 2021, the Council sent its final response to Ms X’s complaints. It said:
• it had contacted the housing association on Ms X’s behalf to discuss her issues getting hot water but it was not the Council's responsibility. All Care had carried out a risk assessment and decided it was not safe for staff to carry the hot water through the flat;
• it had confirmed staff were now wearing correct PPE and Ms X had received her flu vaccination;
• it accepted it had failed to communicate its decision to reduce Ms X’s care package to her. It apologised and said it would remind staff to communicate with her about changes to her care and support;
• it was satisfied it had properly assessed Miss X’s needs and considered what support she needed. However, if Ms X agreed, it would do a new assessment;
• if Ms X now willing to have someone visit, it would make the referral to the falls alarm service; and
• it would coordinate a Multi-Agency Risk Management meeting (MARMM). The MARMM would assess the risks to Ms X and decide what actions the organisations involved with her care could take to support her.
32. Later that month the Council carried out a needs assessment. There was no significant change to the assessment. It stated Ms X still did not have hot water and was aware she would need to contact her energy provider.
33. In early April an OT carried out a telephone assessment with Ms X. They considered Ms X’s request for a stairlift but decided they would not recommend a stairlift as the Council would not receive the relevant permissions.
34. Ms X wrote to the Council to say she was unhappy she still did not have a social worker.
35. The Council allocated Ms X a social worker in late April. In response to my enquiries, the Council told me it can take up to eight weeks to allocate someone a social worker. There had been a delay because a manager went on long-term sick leave. It said it will look at how to ensure teams are supported when managers are on leave.
36. In late July 2021, the Council held the MARMM. It found:
• Ms X had not left her home in over a year. The property was cluttered and presented a risk to her. She had refused to allow any carers into the home for some time and there were concerns about her ability to manage her personal care;
• the Council would carry out a review of Ms X’s needs to see if her care package should increase from one hour per week and to address her concerns about the quality of care All Care offered;
• Ms X’s home was not suitable for a DFG to install a stairlift;
• the Council had made the falls referral but Ms X would need to have a key safe fitted. Ms X did not agree as it made her feel vulnerable; and
• it agreed steps to try and resolve Ms X’s housing situation.

Care visits

37. Ms X said All Care have not been visiting at the times specified in her care plan. Ms X’s care plan states the Care Provider will visit twice a week from 10:00 to 10:30. The Care Provider told me it does not prioritise visiting in those times as Ms X does not let staff into her home so it is only carrying out a welfare check and taking the rubbish from outside Ms X’s door downstairs.
38. I have reviewed All Care’s records of its visits from September 2020 to May 2021. The records show the carers mostly visited Ms X at the time specified in her care plan or slightly outside of those times.

Duty to refer

39. Ms X said the Council did not make a referral to other councils’ housing departments despite her asking for it to. In June 2020, the Council agreed to complete a referral to another council (Council B) so that it could consider Ms X’s homelessness application. The Council sent the referral the same day. The following month, Ms X asked the Council to make a referral to Council C. It did so the following day. In August, Council C contacted Ms X to say it had not received a referral from the Council. The Council resent the referral the following week.

Findings

Needs assessments and care planning

40. Ms X complained the Council delayed assessing her need for care and support and failed to send her the outcome of its assessment. The Council carried out the needs assessment within a month of Ms X contacting it in March 2020. There was no undue delay so the Council was not at fault.
41. However, the Council cannot evidence it sent the needs assessment or care and support plan to Ms X. On balance, I consider it did not do so, which was fault. However, records show Ms X accessed some of the support set out in the plan and refused other support. I am therefore satisfied she was aware what support was available and the injustice the fault caused her was frustration.
42. In September 2020 All Care told the Council it wanted to end Ms X’s care package of five and a half hours per week. The Council therefore reduced Ms X’s care package to one hour. The Guidance states if a council becomes aware a care plan may be unsuitable it should immediately review the plan. It should do this with the person’s input. The Council was at fault for failing to carry out a review before reducing Ms X’s care package. Ms X only became aware the care package was reduced when All Care told her. This caused her undue distress. In its complaint response, the Council accepted it had failed to communicate its decision to Ms X. It said it would remind staff they should communicate support changes to Ms X. While I welcome this action, I do not consider it appropriately addresses the fault or injustice the fault caused Ms X. I have therefore made further recommendations.
43. Ms X is unhappy the Council has not reinstated her previous care package and feels it failed to support her with her falls, washing and accessing the community. The Ombudsman cannot question a council's decision if it is made without fault. After it reduced Ms X’s care package, the Council carried out a needs assessment in November 2020 and a further assessment in March 2021. The Council properly considered Ms X’s needs and circumstances in its needs assessments. However, Ms X refused to allow carers into the home to provide the support to meet all her needs. The Council therefore maintained the one-hour package. The Ombudsman would not expect the Council to continue to pay for a service if a person was not accepting it. There was no fault in the Council's decision-making process so I cannot question its decision.
44. The Council accepted Ms X was at risk of falls and repeatedly offered to make a referral to a falls alarm service. The service is the body best placed to support Ms X with her falls, but she would not agree to the referral because it would involve someone coming into her home and later fitting a key safe outside her door. The Council took appropriate steps to support Ms X in preventing falls so was not at fault.
45. The Council's assessments found Ms X needed support from carers to wash. However, issues with the safety of her gas supply and accessing the meter to top it up meant she did not have access to running hot water. The Council is not responsible for ensuring the continuity of Ms X’s gas supply. It encouraged her to speak with her utility provider and housing association to resolve the issue. It also spoke with her housing association to highlight the issue and considered whether it could make a disabled facilities grant to fit a stairlift to allow her to reach the meter. The Council took appropriate action to address Ms X’s concerns about the hot water so was not at fault.
46. All Care initially carried kettles from the kitchen to the bathroom, but later carried out a risk assessment which found that was not safe for staff. Ms X says this meant she could only have a wash using wipes and could not wash her hair. All Care is responsible for ensuring the safety of its staff in their caring duties. It was not at fault for deciding they could no longer carry the kettles.
47. Following the first needs assessment in March 2020, the Council referred Ms X to a local charity for support in accessing the community. The Guidance is clear that councils can consider whether support other than formal care is appropriate to meet a person’s needs. There was no evidence of fault in how the Council decided the charity could help Ms X access the community. Ms X chose to use the service to have help emptying her bins.
48. In December 2020, the Council told Ms X it would allocate her a social worker to carry out a new needs assessment and explore what other support was available. The Council told me it normally takes eight weeks to assign a social worker and accepts it took longer than it should have in this case because a manager was on leave. The Council did not allocate a social worker until late April. This was fault. I consider this caused drift in progressing Ms X’s case, particularly in exploring other support available to her. However, once the Council allocated the social worker, they acted appropriately by arranging the MARMM which looked how organisations involved with Ms X could support her. The delay in allocating the social worker and resultant drift caused Ms X distress. The Council has set out action it will take to prevent the fault occurring again and I am satisfied no further service improvements are needed.

Disabled Facilities Grants

49. Ms X wanted a DFG for a stairlift and to move her utility meters upstairs. She is unhappy the Council did not offer her a DFG when she spoke the OT in June 2020. It is for the OT, using professional judgement, to recommend what equipment or adaptations Ms X might need. They did so based on the information available at the time and provided Ms X with some equipment. There was no evidence of fault.
50. In April 2021, the OT carried out another telephone assessment but did not recommend the Council use a DFG to install a stairlift. This was because the stairlift Ms X wanted would have to be installed in the housing association building’s communal area and it would not get the relevant permissions. The OT considered the relevant information, so the Council was not at fault.
51. There is no evidence the Council responded to Ms X’s request for DFG to move her utility meters so she could reach them to top up her account. However, I do not intend to investigate this further. This is because moving utility meters is not a valid use of a DFG.

Care Visits

52. Records show the Care Provider mostly visited Ms X at or around the time of her care visits. Given the carers only visit to carry out a welfare check and remove Ms X’s bins I do not consider the delayed visits amount to fault.

Duty to refer

53. Given Ms X told the Council she did not want to live in its area, the Council’s role in relation to her risk of homelessness was limited. It has a duty to refer those it considers at risk but is not responsible for dealing with the homelessness. There is no timescale for making a referral to a council’s housing department. The Council responded to Ms X’s referral requests promptly and when it became aware Council C had not received the referral, sent it again. It was not at fault.

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Agreed action

54. Within one month of the date of my final decision, the Council will apologise to Ms X for the distress and frustration caused by the faults identified in this decision.
55. Within three months of the date of my final decision, the Council will remind its staff they must carry out a care and support plan review before reducing someone’s care package.

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Final decision

56. I have completed my investigation. I have found fault leading to personal injustice. I have recommended action to remedy that injustice and prevent reoccurrence of this fault.

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Investigator's decision on behalf of the Ombudsman