The Ombudsman's final decision
Summary: Ms Z, on behalf of Mr X, complained about the Council’s actions in respect of a Care Act assessment and its failure to properly communicate with him about this causing distress. There is evidence of fault as the Council delayed in providing the care package, failed to provide full advice about the financial assessment and failed to properly communicate with him. A remedy is agreed in addition to the actions already taken by the Council.
The complaint
Ms Z, on behalf of Mr X, complained the Council: Failed to explain why care was not provided after a care needs assessment in 2019; Delayed in completing a care assessment in 2020; Delayed in providing care until November 2020 after assessing Mr X had eligible care needs and failed to keep him informed; Considered moving Mr X to residential care without any assessment identifying this need; Failed to provide a proper financial assessment including consideration of Disability Related Expenses and the minimum income guarantee; Failed to inform Mr X his named social worker was no longer his case worker and delayed in providing a new social worker; Failed to provide alternative provision after the care provider ended its services in April 2021; and Delayed in completing a review of Mr X’s care needs until September 2021 and then failed to properly assess his care needs.
Ms Z says the lack of support caused Mr X mental health distress, malnutrition, self neglect and led to alcohol and drug dependence.
The Ombudsman’s role and powers
We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word ‘fault’ to refer to these. We cannot question whether an organisation’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) 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(i), as amended)
How I considered this complaint
As part of the investigation, I have: considered the complaint and the documents provided by the complainant and his representative; made enquiries of the Council and considered the comments and documents the Council provided; discussed the issues with the complainant and his representative; sent my draft decision to both the Council and the complainant’s representative and taken account of their comments in reaching my final decision.
What I found
Mr X has autism spectrum disorder (ASD) and also suffers from mental health issues. The Council completed a care needs assessment in August 2020 which found Mr X had eligible care needs. The assessment initially determined Mr X should have 10.5 hours per week split into three visits per day of 30 minutes each. His care package was later increased to 14 hours per week to recognise Mr X’s level of needs.
Ms Z has raised a number of specific complaints on behalf of Mr X, I will deal with each in turn.
Failed to explain why care was not provided after a care needs assessment in 2019 A duty social worker visited Mr X at home and determined a Care Act assessment was required. The Council says that following the visit several attempts were made to contact Mr X but were unsuccessful. The social worker then left his role and another social worker arranged a visit. The assessment found Mr X needed assistance with paperwork and support in respect of his mental health and specific autism support. The Council says it signposted Mr X to third sector organisations that could help him. It says that this met his needs and no further support was identified.
Based on the information provided, the care act assessment completed in 2019 identified needs that were met by referrals and signposting. It would appear the assessment did not identify other needs that required services to be commissioned or carers provided. I am not persuaded there is any fault in respect of this issue.
Delayed in completing a care assessment in 2020 On 30 June 2020 the Council received a referral and agreed a priority review was required. A social worker from the Learning Disability and Autism Team was allocated to the case on 1 July. The social worker contacted the mental health service for an update on 15 July and also spoke to Mr X and his mother. The Council agreed the request for 3 x 30 minutes callees per day on 22 July. The social worker completed the Care Act Assessment and Support Plan on 14 August 2020.
The information provided shows the care act assessment in 2020 was completed in just over six weeks. The care needs were identified and approved within three weeks but the final paperwork was not completed until three weeks later. Based on this information, I am not persuaded there was any delay in these actions and so I find no fault.
Delayed in providing care to November 2020 after assessing Mr X had eligible care needs and failed to keep him informed As noted above, the Council identified Mr X’s eligible care needs in July and completed the care assessment by 14 August. However, Mr X did not receive any care until November 2020. The Council has provided a chronology of its actions in respect of finding a care provider for Mr X. This shows the first action happened on 27 August and a week later the Council’s brokerage service sent out a tender to the market. On 18 September a request was sent to all known local providers.
The chronology shows that on 20 October there had been no responses and so the brokerage service sent the request to all general providers with added check around carer experience to be undertaken if any had capacity. The social worker was undated. On 29 October the social worker emailed senior managers explaining Mr X’s condition was deteriorating and he was at risk of self-neglect and suicide. He asked if alternatives could be considered urgently to avoid the situation getting worse. The social worker also looked at the option of Mr X moving to supported living because a care provider had not been found.
On 9 November the Council contacted a care provider which believed it could provide the care visits but it noted it was out of their normal area and so the cost would be higher. The care provider met with Mr X and his mother on 10 November and then contacted the Council. The care provider said that the care plan may need updating because Mr X was displaying severe anxiety issues and there were concerns about self harm and substance misuse. The care provider felt that more time would be required to meet Mr X’s needs.
Mr X began receiving care in November 2020, four months after his needs were assessed. I have carefully considered the information provided about the Council’s actions to find a care provider and I consider there was delay in this case. The Council did make some effort to find a care provider but the chronology suggests a lack of urgency even though there is evidence Mr X’s condition was acute and deteriorating.
The time taken to identify a care provider amounts to service failure, which is fault. Mr X’s needs were identified in July but the care package was not started until November. The delay had a detrimental impact on Mr X and so I consider a payment should be made to recognise this.
While the chronology explains the actions taken to identify a care provider, I have not seen any evidence to show the Council kept Mr X informed of the situation and the reasons for the delay. This too is fault. The Council acknowledged this in its complaint response and accepts if it had kept Mr X informed of its actions that this could have alleviated some of the distress he experienced.
I note the Council has learnt from this situation and that in November 2020 it put in place a dedicated full time broker in the Autism and Learning Disability Team. The Ombudsman welcomes the Council’s actions on this point.
Considered moving Mr X to residential care without any assessment identifying this need Within the chronology provided about the actions taken to identify a care provider, is mention of Mr X moving to a supported living placement. The information suggests this was considered as an alternative because of the issues in appointing a care provider. The Council says that the matter did not proceed as a care provider was identified shortly afterwards.
I acknowledge this suggestion may have been distressing to Mr X. It came at a time that it is also noted his condition was deteriorating. While noting the impact on Mr X, I do not consider it was fault for the Council to explore other ways to meet Mr X’s assessed eligible needs. Based on other information I have seen in connection with this complaint suggesting a lack of communication with Mr X, it is possible the reasons for looking at a supported living placement were not properly communicated with Mr X. This is fault.
Failed to provide a proper financial assessment including consideration of Disability Related Expenses (DRE) and the minimum income guarantee (MIG) The Council completed a pre-service financial assessment on 14 August 2020. This showed a maximum charge of £47.11. The Council wrote to Mr X on 28 August explaining this was a provisional assessment and that once his care started a full financial assessment would be completed.
The Council wrote again to Mr X on 6 January 2021 stating his required personal contribution was £45.96 per week starting from 9 November 2020. The assessment did not explicitly mention the MIG although I note it was used in the calculation. There is nothing to suggest the Council provided information to Mr X about DRE’s.
In response to my enquiries, the Council accepts that the information, advice and guidance provided to Mr X about the financial assessment was “lacking”. It said that while Mr X had capacity in respect of finances, it should have taken the time to speak to Mr X and explain how to apply for DRE’s and to assist him to do this. The failure to provide full information is fault. I am pleased to note the Council has already taken action to remedy this part of Mr X’s complaint by cancelling all invoices for his personal contribution. Mr X has not been charged his personal contribution for all the care provided between November 2020 and April 2021. I consider this to be a suitable remedy.
Mr X says that at one point the Council told him there was a credit in his name of about £600. It is my understanding this credit was raised in order to then offset the invoices. The process required the Council to issue a credit invoice but as Mr X had not paid the original invoices there was no refund due to him.
Failed to inform Mr X his named social worker was no longer his case worker and delayed in providing a new social worker Mr X made a complaint to the Council in February 2021 in which he raised issues about his social worker. Mr X believed the social worker was no longer his allocated worker from December 2020. The Council has clarified that the social worker was involved until January 2021 when he moved to another role. However, it acknowledged that there is no record of this being communicated to Mr X or details provided of who would be his allocated social worker. A new social worker began working with Mr X in April 2021.
The failure to notify Mr X of a change in social worker and the delay in providing a new social worker is fault. This caused Mr X anxiety and was part of the reason he made a formal complaint to the Council.
Failed to provide alternative provision after the care provider ended its services in March 2021 On 15 April 2021 the care provider contacted the Council’s brokerage team and gave notice on the care package it was providing to Mr X. It stopped providing services to Mr X on 23 April. The Council says that on 15 April it spoke to Mr X and to his mother. It says that both confirmed Mr X no longer wanted the care package and that he had made alternative arrangements with family members. It is my understanding this communication all happened by telephone and so I cannot be certain exactly what was said.
I asked Ms Z and Mr X to confirm if the Council was correct when it says Mr X did not want the care package to continue. Ms Z states that Mr X did not cancel his care package. I am satisfied this is correct. The first action in this case was the care provider giving notice. Ms Z also provided a detailed explanation of Mr X’s situation at that time.
Ms Z says that Mr X was increasingly anxious at that time about money and bills and was also feeling restless. Mr X decided to use his mobility allowance to lease a car through the Motability Scheme which would be an additional expense of £63 per week plus the cost of fuel. Ms Z says Mr X discussed the affordability of his care with his mother and one of his carers. This involved the idea to reduce his care from 2.5 hours per day to one six hour leisure activity session per week. The carer would support him on this day and his mother would pay for the session.
Ms Z says that Mr X phoned the Council’s brokerage team to give notice to the Council and he was told he could not cancel his care until he had a meeting with his social worker, however he did not have an allocated social worker at that time. Ms Z says that Mr X assumed his care package would continue until a meeting was arranged but the care in fact stopped abruptly in April.
Based on the information provided, I take the view, on balance, that Mr X did not object to the care package ending. It seems he wanted to change how he spent his money, which he is entitled to do, and change the amount and type of care he received. This seems to me to be a very well thought through decision by Mr X and that it was his intention to end the care package.
Mr X complains the Council failed to provide alternative provision when the care provider gave notice to the Council. Normally it would be the Council’s responsibility to find an alternative care provider but in this case I do not find fault. As explained below, the process to complete a review of Mr X’s care needs was started within two weeks of the ending of the care package on 23 April 2021. As the ending of the care package was in line with Mr X’s wishes and intentions, I am not persuaded he suffered a significant enough injustice to warrant further investigation.
Delayed in completing a review of Mr X’s care needs until September 2021 and then failed to properly assess his care needs.
Following the ending of the care package in April 2021, the Council completed a review of Mr X’s care needs. The Council visited Mr X at his mother’s house on 7 May when it was agreed the assessment would wait until after the outcome of Mr X’s complaint to the Council. A further home visit took place on 1 July. The Council says that during this visit there was detailed discussion about other services available to Mr X including the Autism Hub and calm cafes.
The Council says the review document is dated 3 September as this was the day it was finalised on the computer system but it was started in May and put on hold at Mr X’s request. I find no fault by the Council in respect of the time taken to complete the review of Mr X’s care needs.
The re-assessment did not result in the Council providing a care package. The Council says this is because any Care Act assessment is based on the client’s presentation at the time of the assessment. I note that Ms Z was present to support Mr X at the review meetings and no specific issues have been raised about failings in how the assessment was carried out. The Ombudsman is concerned with administrative process and not the merits of decisions properly reached even though people may disagree with them. While I appreciate Mr X is disappointed with the outcome and would like to receive direct payments to enable him to arrange his own care and respite, no fault has been identified in the review process and so I am unable to criticise the decisions reached.
Agreed action
To remedy the injustice caused to Mr X as a result of the faults identified in this case the Council will, within one month of my final decision, take the following action: Apologise to Mr X; and Pay Mr X £250 to recognise the distress caused as a result of the delay in sourcing a care provider and lack of communication.
Final decision
I have completed my investigation with a finding of fault for the reasons explained in this statement. The Council has agreed to implement the actions I have recommended. These appropriately remedy any injustice caused by fault.
Investigator's decision on behalf of the Ombudsman