This fact sheet is aimed primarily at people and their carers who have problems concerning community care assessments and may be considering making a complaint to the Ombudsman.
I am unhappy about the way in which the council has carried out my community care assessment. Can the Ombudsman help me?
In some cases, yes. The Ombudsman cannot question the merits of decisions, or professional judgements, where they have been reached properly. But we can consider how those decisions are reached and whether they have been implemented properly.
The law says that where it appears to a council that any adult may need care and support within its area, the council must carry out an assessment of his or her needs for such services. The council must then decide whether the person’s needs call for the provision by it of any such services. This is regardless of whether or not the council thinks the adult has eligible needs or of their financial situation.
Councils also have a duty to offer a carer’s assessment, where an individual provides or intends to provide care for another adult and it appears that the carer may have needs for support. If the carer’s assessment shows the carer has eligible needs, the council must meet these. It is not necessary that the person cared for has eligible needs, in order for the carer to be supported.
There is no specific timescale for how long it should take for a community care assessment to be carried out. But the Ombudsman normally considers that it is reasonable for this to take between four and six weeks from the date of the initial request. However, for individuals with more complex needs we recognise that it can take longer, especially if information is required from other agencies. If there has been a delay by those agencies in providing the information needed, councils should be able to demonstrate that they have taken reasonable steps to obtain that information.
Councils should take into account the views of the person being assessed and, if appropriate, their carers. They should also work with other agencies towards a single combined assessment in order to avoid delays and duplication.
The national eligibility criteria set a minimum threshold for adult care and support needs, and carer support needs, above which the council should meet the identified needs. An adult’s needs are only eligible where they meet all three of the following conditions:
- If an adult’s care and support needs arise from or are related to a physical or mental impairment or illness
- If, as a result of the adult’s needs, the adult is unable to achieve two or more of the specified outcomes.
- If, as a result, there is, or is likely to be, a significant impact on the adult’s wellbeing.
Once an assessment is completed, the council should share with the service user their written record of what services the person requires, and how these will be provided (the Care Plan or Support Plan).
How do I complain?
You should normally complain to the council first. We will not normally consider a social services complaint until the council has had the opportunity to consider and resolve it locally.
You should normally complain to us within 12 months of becoming aware of the issue. When you make a complaint to social services you should be given information about what will happen to your complaint and how long this will take.
The council should agree with you a plan for how it will deal with your complaint, including a timescale. You can complain to us if you’re not happy with the outcome, once the council has completed its consideration of your complaint.
If you can consider my complaint what will the Ombudsman look for?
We consider whether there is fault in the way the council has dealt with a person’s assessment for community care services and whether they have suffered as a direct result. Some faults we might find are that the council:
- failed to consider properly the complainant’s needs and circumstances.
- failed to make an assessment of the carer’s needs or to take a reasonable account of the care a carer is able to provide
- failed to involve the carer in the assessment of the cared for person
- failed to obtain relevant information from other key agencies, or failed to chase up that information, or
- delayed unreasonably in carrying out an assessment.
What happens if the Ombudsman finds that the council was at fault?
It depends on the fault and what the consequences are. We must consider what injustice has been caused to the complainant or service user as a result of what went wrong, and how best that can be put right. So if, for example, there are errors in a care assessment, we first ask the council to reassess the person and think again about the services they may need. We might then ask the council to provide a remedy to that person for any injustice caused by the previously inadequate assessment. This might include a financial remedy for the impact caused by the inadequate assessment.
Examples of some complaints we have considered
Other sources of information
See Civil Legal Advice (CLA) at www.gov.uk/civil-legal-advice or call 0345 345 4 345 to check if you can get legal aid.
Age UK at www.ageuk.org.uk or call 0800 055 6112
Carers UK at www.carersuk.org or call 0808 808 7777
Our fact sheets give some general information about the most common type of complaints we receive but they cannot cover every situation. If you are not sure whether we can look into your complaint, please contact us.