The Ombudsman's final decision
Summary: The Council failed to provide support to Mr B with applying to charities for a carpet which he said he needed to be able to use his wheelchair upstairs and it failed to carry out a review when he said his care needs had increased. It also wrongly decided that Mr B had been overpaid direct payments and told his carer that they would not get paid, which contributed to Mr B being left without care. The Council later decided to stop paying direct payments to Mr B but failed to follow the correct process. The Council also delayed dealing with Mr B’s application for the household support fund and for a disabled facilities grant for a downstairs toilet. The Council’s failings have caused Mr B significant distress and meant that he has had difficulty accessing a toilet and moving around his home. The Council has agreed to make some payments to Mr B and to take action to prevent similar failings in future.
The complaint
Mr B complains that the Council is failing to ensure his social care needs are met. In particular, Mr B complains that the Council: did not apply to charities for a carpet which he needs to be able to use his wheelchair upstairs without the assistance of carers; failed to deal with his request to increase his direct payments so that he can pay his carers to help him access the bedroom and toilet until the carpet is replaced; failed to involve him in a financial assessment which led to the wrong information being submitted and the Council stopping his direct payments; wrongly told his carer that he would not be paid for the next four months which resulted in his carer leaving and Mr B being left without care, and then failed to take prompt action to resolve the situation; will not authorise foodshare vouchers, despite being told that Mr B cannot afford food; delayed dealing with his application for the household support fund; reduced his direct payments without notice or explanation leaving him unable to pay his carers; and delayed dealing with his application for a Disabled Facilities Grant.
Mr B says that the Council's failings have caused him significant distress and hardship. He says that as a result of the Council's failings, he has been left without food and without care, leaving him unable to access a toilet or his bedroom.
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 significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended) We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. (Local Government Act 1974, sections 26B and 34D, 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)
What I have and have not investigated In January 2022, Mr B complained to the Council about various matters, including the length of time it took before the Council started paying direct payments to him in February 2021, and the Council not providing any additional support when his partner’s health was declining between February and August 2021. The Council responded to Mr B’s complaint in February 2022 and advised Mr B that he could complain to us if he remained dissatisfied. Mr B did not complain to us in the following 12 months. I consider it would have been reasonable for Mr B to do so, and so there are no grounds to exercise discretion to investigate this aspect of Mr B’s complaint now.
How I considered this complaint
I have: considered the complaint and the documents provided by the complainant; discussed the issues with the complainant; made enquiries of the Council and considered the comments and documents the Council has provided; and given the Council and the complainant the opportunity to comment on my draft decision.
What I found
Legislation and government guidance Care and Support Plan Where a council has a duty to meet an adult’s need for care and support, it must prepare a care and support plan. (Care Act 2014) The 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.
If there is any information or evidence that suggests that circumstances have changed in a way that may affect the efficacy, appropriateness or content of the plan, then the council should immediately conduct a review to ascertain whether the plan requires revision.
In addition to the duty on councils to keep plans under review generally, the Act provides a duty on the local authority to conduct a review if a request for one is made by the adult or a person acting on the adult’s behalf. (Care and Support Statutory Guidance 2014) Direct payments Direct payments are paid to people to enable them to arrange their own care and support to meet their eligible care and support needs.
The council can discontinue payments if the person fails to comply with a condition to which the direct payments are subject or if for some reason the council no longer believes it is appropriate to make the direct payments. For example, the council might discontinue the direct payment if it is apparent that they have not been used to achieve the outcomes of the care plan. (Care and Support Statutory Guidance 2014) If a council is considering discontinuing direct payments, it should discuss it with the individual as soon as possible, in order to explore all available options before making the final decision to terminate the direct payments. (Care and Support Statutory Guidance 2014) Disabled Facilities Grants Under the Housing Grants, Construction and Regeneration Act 1996, councils can award Disabled Facilities Grants to people whose disability means their home needs adaptation. If the person applying meets the qualifying criteria the council must award the grant.
Councils should make decisions about grants as soon as they can and must do so within six months of the date of receiving a valid grant application. Works should be completed and grants paid within 12 months of an application being approved.
Optalis Optalis provides adult social care services on behalf of the Royal Borough of Windsor and Maidenhead Council. When a council commissions another organisation to provide services on its behalf it remains responsible for those services and for the actions of the organisation providing them. I have referred to both the Royal Borough of Windsor and Maidenhead Council and Optalis as ‘the Council’ in this statement.
Background and key events Mr B is a wheelchair user and lives on his own in a two-bedroom house. He receives direct payments from the Council to pay for the care he needs. Following a review of Mr B’s care needs in November 2021, the Council decided to increase Mr B’s personal budget so that he could have three hours of care each day.
Before June 2023, there was one toilet in Mr B’s home, which was upstairs. He is able to access the upstairs by using a through floor lift but says he cannot move around upstairs without the assistance of a carer. He says there are gaps in the floorboards which are covered up with bits of old carpet which he cannot get his wheelchair across by himself.
In around April 2022, Mr B asked the Council for support with getting funding for a carpet upstairs, a washer-dryer and a downstairs toilet. Mr B says that he also asked the Council to increase his personal budget because he needed more care until the carpet was fitted.
The Council contacted a charity which agreed to fund a washer-dryer and it approved a Disabled Facilities Grant to pay for a downstairs toilet to be installed. The washer-dryer was purchased in November 2022 and the works to install the toilet were completed in June 2023.
In December 2022, Mr B’s mother, Mrs X, made a formal complaint on Mr B’s behalf. She said that Mr B’s condition was progressing to the point that he needed a powered wheelchair but one would not be supplied until his accommodation was made safe for one by fitting a carpet upstairs. Mrs X said that Mr B had obtained quotes and contacted charities, five of which had agreed to part fund the carpet which together would cover the total cost. She said that the applications needed to be completed by a social worker but they had not been done, despite Mr B providing all the necessary information in March.
In the Council’s response, it said that it had not received any information to show that the upstairs carpet was preventing Mr B from having a powered wheelchair. It said that the Occupational Therapist had advised the carpet could be removed to provide a more even surface.
The Council told Mr B that it would be speaking to him about him moving into supported accommodation but said that if he declined this, it would confirm which five charities had agreed to pay for carpeting and it would complete the necessary forms in a timely fashion.
Another complaint was made on Mr B’s behalf in May 2023 after Mr B’s social worker sent an email to his personal assistant advising that Mr B had been overpaid and so he would not receive any direct payments for the next four months.
Mr B says this led to his personal assistant leaving. He says that despite his personal assistant contacting the Council immediately to advise that Mr B needed emergency care, he was left without any care for around three weeks.
Mr B contacted the Council’s financial team and it was identified that he had not been overpaid; the error had been caused by his rent not being included in a financial assessment.
Mr B says that, in around April 2023, he asked the Council about applying for the Household Support Fund, which is a fixed amount of money which can be paid to someone who is vulnerable and cannot pay for essentials. Mr B says the Council failed to respond to his emails and as a result, he did not receive the payment until September 2023.
Mr B says that due to errors by the Council, he has not always received the direct payments he was entitled to which left him unable to pay his carers. He gave an example of a payment he received in August 2023, which he says was over £700 less than expected.
Mr B’s care needs were reviewed in November 2023. It was agreed that three hours of care each day was adequate to meet his needs.
In December, following concerns regarding the management of Mr B’s personal budget, the Council decided to stop his direct payments and to instead provide a commissioned package of care. Mr B has refused to accept the care offered. He says he does not want strangers in his house and he considers his direct payments have been stopped in retaliation for his complaint to the Ombudsman.
Analysis Charity applications The evidence suggests Mr B first asked the Council for support with funding a carpet in around April 2022. Little action appears to have been taken before Mrs X complained to the Council in December. Despite the Council agreeing in January 2023 that it would complete the necessary forms in a timely fashion, the Council had only applied to two of the five charities by May. In an email dated 11 May 2023, Mr B’s social worker said that another social worker would be taking over Mr B’s case and would help complete grant applications for the other three charities. I have seen no evidence that applications to these charities were completed.
The Council’s delays and failure to take the action it agreed to take are fault. If the Council had completed the applications promptly, as it should have done, I consider it likely that Mr B would have had a carpet upstairs since around July 2022, which would have made it easier for Mr B to move around upstairs when his carers were not in attendance.
Request for personal budget to be increased Mr B told his social worker in February 2023 that he could not use the upstairs rooms without the assistance of a carer, and he requested a temporary uplift to his direct payments while the upstairs was unusable. I have seen no evidence of any attempt to review Mr B’s care needs until June 2023. This was fault.
Mr B refused to have a review of his needs in June but one was carried out in November 2023. It was decided during that review that, following the installation of the downstairs toilet, the three hours of care Mr B was already receiving were adequate to meet his needs. If a review of Mr B’s care needs had taken place shortly after he told the Council that his needs had increased in February 2023, as it should have done, I consider the Council may have increased his direct payments temporarily until June 2023, when the downstairs toilet was installed.
Disabled Facilities Grant Councils should make decisions about grants as soon as they can and must do so within six months of the date of receiving a valid grant application. Works should be completed within 12 months of an application being approved.
In April 2022, following Mr B’s request for a Disabled Facilities Grant for a downstairs toilet, his social worker put in a referral for an occupational therapy assessment. The Occupational Therapist carried out the assessment around two months later and requested a joint feasibility visit after a further three months. This delay was fault.
After the joint feasibility visit took place in October, a fast-track application was submitted which was placed on a waiting list. The Council did not accept the application as valid until February 2023. The application was then approved on 17 May and the works were completed on 21 June.
Placing the application on a waiting list is a form of gatekeeping and appears to be an attempt to circumvent the requirement to assess applications within the six-month time limit. This is not appropriate and is fault.
If there had been no fault by the Council, I consider the application would have been submitted by August and approved by February 2023.
As the works were completed within a month of approval, I consider it likely that if the application had been approved by February 2023, the works would have been completed by March, around three and a half months earlier than they were completed. I consider Mr B had difficulty accessing a toilet without the assistance of a carer for around three and a half months due to the Council’s delay here.
Financial assessment The Council failed to include Mr B’s rent in the financial assessment it carried out in May 2023. This resulted in the Council wrongly deciding that he had been overpaid direct payments. Mr B’s social worker then told Mr B’s personal assistant that he would not receive direct payments for four months which he says led to him being left without care.
When Mr B contacted the Council on 15 May, it arranged a commissioned service of care to start from that evening. It continued until the evening of 17 May when Mr B’s preferred carers were reinstated. If Mr B had contacted the Council on 13 May, rather than waiting until Monday 15 May, it may have been able to arrange a commissioned service sooner.
The Council has accepted there were failings in the way the overpayment was communicated to Mr B’s personal assistant. As a result of Mr B’s complaint, the Council has set up a communication plan to ensure there is a clear process which will prevent care breakdown in future. I consider it likely that the way the overpayment was communicated to Mr B’s personal assistant contributed to Mr B not receiving any care between the evening of Saturday 13 May and the evening of Monday 15 May.
Irregular payments Mr B complained that the payment he received in August 2023 was over £700 less than expected, which left him unable to pay his carers. The payment Mr B is referring to was paid in addition to Mr B’s regular payment. I have seen no evidence that the Council has regularly paid the wrong amount to Mr B leaving him unable to pay his carers. I also note that the direct payments are made in advance, which gives four weeks for any concerns to be raised.
Termination of direct payments The Council wrote to Mr B on 14 December 2023 setting out the reasons why it had decided to stop making direct payments. While direct payments can be stopped for these reasons, the Council did not have a discussion with Mr B to explore alternative options before making the final decision to terminate his direct payments. This was fault.
A minimum period of notice should be established before direct payments are discontinued. The Council gave Mr B ten days notice, and as payments were made in advance, no further payments were made. I do not consider the Council gave Mr B sufficient notice before the direct payments were stopped. This was fault.
Mr B says that he has stopped paying his rent to enable him to pay his carers and as a result, his landlord is taking action to repossess his home. I do not consider this is due to the failings identified because Mr B could have accepted the alternative care the Council arranged. However, I consider the way the Council decided to stop Mr B’s direct payments caused him significant distress and has left him with uncertainty as to whether it may have been possible for him to continue using the same carers if he had been offered support to manage his personal budget.
Foodshare vouchers The Council’s records show that it provided Mr B with foodshare vouchers for most of 2022, which enabled him to use a foodbank. Mr B says his social worker decided that this should only be a temporary measure and will not supply any more vouchers.
In late 2022, the Council was working with Mr B to support him with his financial situation, but it was felt that Mr B was vague with figures and he did not provide all the evidence it needed to properly understand his financial situation.
The Council has not commented on Mr B’s claim that it is refusing to supply him with any more vouchers but there is generally a limit on the number of times a food bank can be used. The Council should only provide foodshare vouchers to someone it considers needs food on a short-term basis. I consider further investigation of this aspect of Mr B’s complaint is unlikely to find evidence of fault.
Household support fund The Council says that Mr B applied for the household support fund on 14 September and it was paid on 19 September 2023. However, the evidence shows that this was Mr B’s second attempt to complete the application and he had been asking for support to apply since at least July. On the balance of probabilities, I consider it likely that Mr B had been asking how to apply for the household support fund since around April 2023. The Councils delay in providing support to Mr B was fault and would have caused him frustration.
Agreed action
Within four weeks of my final decision, the Council will take the following actions: Apologise to Mr B for the failings identified in this case. The Council should consider our guidance on remedies when making the apology.
Make a payment of £1050 to Mr B. This is a symbolic sum to recognise that if there had been no fault by the Council, Mr B would likely have had a carpet upstairs around 21 months sooner, which would have made it easier for him to move around upstairs when his carers were not in attendance.
Make a payment of £350 to Mr B. This is a symbolic sum to recognise that if there had been no fault by the Council, the downstairs toilet is likely to have been installed around three and a half months earlier, which would have made it easier for Mr B to access a toilet without the assistance of a carer.
Make a payment of £100 to Mr B. This is a symbolic payment to recognise that the Council’s failings contributed to Mr B being left without care for two days in May 2023 which caused him significant distress.
Makes a payment of £500 to Mr B. This is a symbolic payment to recognise the significant distress Mr B experienced as a result of the way it stopped his direct payments in December 2023.
Meets with Mr B to discuss how his needs can be met in future. It should consider whether Mr B can be supported to manage his personal budget. If the Council remains of the view that he should not receive direct payments, it should provide him with support to end his contractual responsibilities, in accordance with paragraph 12.84 of the care and support statutory guidance.
Applies to charities to obtain the remainder of the funding needed to cover the purchase and fitting of an upstairs carpet. If the Council is unable to obtain the necessary funding within three months of my final decision, it should pay for a carpet to be fitted itself.
I recommend that, within three months of my final decision, the Council: Takes action to ensure social workers promptly respond and action requests for support.
Reviews its procedures for Disabled Facilities Grants to ensure applications are made promptly and they are approved within the timescales set out in legislation.
The Council should provide us with evidence it has complied with the above actions.
Final decision
I have completed my investigation and uphold Mr B’s complaint. There was fault by the Council which caused injustice. The action the Council has agreed to take is sufficient to remedy that injustice.
Investigator’s decision on behalf of the Ombudsman
Investigator's decision on behalf of the Ombudsman