Summary: Mrs W complained on behalf of two relatives about the Council’s delay carrying out financial assessments for the support they received at home. She also complained about delays in the Council’s complaints procedure. The Council was at fault for delaying financial assessment for one of the relatives which meant she missed some direct payments. The Council has agreed to pay the relative the equivalent of the missed payments. The Council has apologised for its delays in the complaints procedure and that is an appropriate remedy. The Council has also agreed to complete the outstanding recommendation from the complaints procedure.

The complaint

1. Mrs W complained on behalf of two relatives about the Council’s delays in assessing their need for financial support towards the care they received at home. She said, because of the delays, one relative only received one month of financial support before she went into a care home and the other relative received no financial support before he died.
2. Mrs W also complained about delays by the Council when it dealt with her complaint about the financial assessments. She said, as a result, she was put to unnecessary time and trouble chasing up the Council for responses.

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The Ombudsman’s role and powers

3. 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)
4. When considering complaints, if there is a conflict of evidence, we make findings based on the balance of probabilities. This means that we will weigh up the available relevant evidence and base our findings on what we think was more likely to have happened.
5. 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

6. I have considered:
• information from the complaint, from telephone calls with Mrs W and documents she provided;
• information from the Council’s complaints procedure; and
• the Council’s response to my enquiries about the complaint.
7. Mrs W and the Council had the opportunity to comment on my draft decision. I have considered the comments received before making this final decision.

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Legal Background

Care Act assessments

8. Under the Care Act 2014 a council must carry out an assessment for any adult with an appearance of need for care and support. The Care and Support (Eligibility Criteria) Regulations 2014 sets out the eligibility threshold for adults with care and support needs and their carers. Where a council determines a person has eligible needs, it must meet those needs.

Paying for care and support

9. Councils can make charges for care and support services they provide or arrange. Where they make such charges councils must assess a person’s finances to decide what contribution he or she should make to a personal budget for care.
10. Direct payments are cash payments made by councils to individuals, allowing them to arrange and pay for eligible care and support themselves.

NHS continuing healthcare

11. NHS continuing healthcare (CHC) is a package of care arranged and funded solely by the health service in England. It is for people aged 18 or over to meet physical or mental health needs that have arisen because of disability, accident or illness. The NHS can provide continuing healthcare at home or in a care/nursing home.

The statutory adult social care complaints procedure

12. The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 require councils to make arrangements for handling adult social care complaints. The only time limit the regulations set out is that, normally, it should take no more than six months to complete a complaints procedure.

The Council’s adult social care complaints procedure

13. The Council’s procedure says:
• the Council will acknowledge receipt of a complaint within 3 working days and say who is the lead manager for the case;
• the lead manager will normally contact the complainant within 5 working days and arrange to discuss the complaint;
• together, the complainant and lead manager will draw up a complaints resolution plan with an agreed, reasonable timescale to complete the actions in it. No overall time target is given;
• the lead manager will keep the complainant updated throughout; and
• at the end of the procedure the complainant may still complain to the Local Government and Social Care Ombudsman.

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What I found

14. Mrs W’s relative, Mrs X, lived with her adult son, Mr Y. Mrs X supported
    Mr Y as he had learning difficulties and health issues and could not live independently.
15. Mrs X began to find it more difficult to look after herself and her son. Mrs X’s family took turns to stay with her and Mr Y. Mrs X was diagnosed with dementia. The family still stayed with Mrs X and Mr Y but arranged for a personal assistant to spend five mornings a week there as well. The personal assistant provided help with meals and personal care for Mrs X and Mr Y and also with activities for Mr Y.

Events January -September 2019

16. In January 2019 Mrs W says she asked the Council if Mrs X and Mr Y were eligible for any financial support to help pay for the cost of the personal assistant. The Council’s record of this contact does not refer to the personal assistant but refers to difficulties the family was having maintaining the support they gave. The record says, “The family are attempting to source care privately but would like a Care Act assessment and a financial assessment in case [Mrs X or Mr Y] are entitled to financial support.”
17. The Council decided to allocate a social worker to Mrs X. The social worker would assess Mrs X’s needs and decide if Mr Y needed an assessment of his needs too.
18. A Council officer, Officer B, visited Mrs X and her daughter, Mrs Z, in
    February 2019. At the visit the officer started an assessment of Mrs X’s care needs. Officer B went on extended leave shortly afterwards. Except for the appointment itself, there is no reference to the assessment visit in the Council’s electronic case notes for Mrs X. The only record the Council has of the visit is the officer’s handwritten notes at the time and these were retrieved as part of the complaints procedure after September 2019.
19. The handwritten notes show Mrs X’s care needs were discussed. However, they make no reference to Mrs X’s eligibility for support. The notes show Officer B was aware the family already employed a personal assistant. The notes suggest Officer B considered direct payments to help with paying for the personal assistant. The notes say Mrs Z had power of attorney for Mrs X’s finances. They make no reference to the need for financial assessment. They contain no specific conclusions or recommendations from the visit.
20. Mrs W says Officer B told Mrs X and Mrs Z the next step would be the financial department contacting them about direct payments as the family already had the support in place.
21. Officer B reported back to the Council’s Learning Disability, Autism and Transition Team. Mr Y was not known to the Team. The Team allocated a social worker, Officer C, to assess Mr Y’s needs.
22. In mid March 2019, after Officer B went on leave, another officer was asked to check her caseload and called Mrs Z. The officer recorded Mrs Z said the family had arranged a private package of home support for Mrs X which everyone was happy with and there was no need for a social worker to visit.
23. Mrs W says the officer told Mrs Z the Council needed to assess Mrs X’s needs, unaware of Officer B’s visit in February. Mrs W says Mrs Z told the officer
    Officer B had already assessed Mrs W’s needs and the family did not need the Council to arrange any other care than that being provided. This was because the family were still happy with the care they had organised. The family still wanted to know if the Council could help with financing the care and Mrs Z assumed the financial department would be in touch soon. But Mrs Z did not mention finances and the Council’s records show no discussion of finances.
24. The same day Officer C visited to assess Mr Y’s care needs. The officer assessed that Mr Y could not live unsupported and he had eligible needs. The assessment referred to Mr Y getting informal support from family and friends. It said Mrs X had formal support of her own due to her own needs. The assessment also said Mr Y was now receiving palliative care only for his health condition. It said a CHC checklist would be completed with Mr Y, family and relevant health professionals.
25. At the end of March 2019 Officer C noted they sent Mrs Z information about NHS continuing healthcare (CHC). Officer C also discussed the CHC process with
    Mrs Z in early April. The officer noted the family did not want formal support for
    Mr Y and, as a result, did not want to progress with CHC. The notes say the family were aware CHC could be progressed, and formal support provided, should the informal support become unsustainable.
26. The Council’s records for Mr Y show in early May 2019 Mrs W rang Officer C asking for an update on the funding request for Mrs X. Officer C said they would contact Officer B and discuss the case. The Council’s record for Mrs X does not refer to Mrs W’s telephone call.
27. In early June 2019 Officer C rang Mrs Z to check on Mr Y. The Council’s records say Mr Y was doing well and Mrs Z did not feel a formal support plan was needed yet.
28. In late June 2019 Mrs Z rang the Council. The Council’s records show she asked for the result of Mrs X’s assessment in February. An officer called back and explained the Council’s records showed the family paid for care privately and did not need help. Mrs Z said Mrs X’s savings were now well below the financial threshold. The officer agreed to refer Mrs X for both a financial assessment and a new assessment of her care needs.
29. In July 2019 Mr Y went into hospital. His social worker became involved to plan for the support he would need when he went home. The Council noted the family wanted the same support worker to visit for each of four calls a day. The Council could not guarantee that and noted the family decided to source their own support for the time being.
30. Mrs W says the family wanted the personal assistant who visited already to keep helping as normal as she provided everything Mrs X and Mr Y needed. They did not want someone else visiting just for Mr Y as they felt it would not work. So in late July they did refuse the Council’s offer.
31. At the end of July 2019 an officer visited to carry out a care assessment for
    Mrs X. The officer assessed Mrs X had eligible needs and recommended
    Mrs X get direct payments towards paying for the personal assistant.
32. Mr Y was discharged home in early August 2019 but was soon re-admitted to hospital.
33. In mid-August 2019 the Council agreed direct payments for Mrs X. At this point the Council had not arranged a financial assessment.
34. A few days later Mr Y died.
35. At the end of August Mrs Z rang the Council to chase up the financial assessment for Mrs X. A Council officer then visited Mrs X in early September 2019 to carry out the financial assessment. As a result the Council agreed to contribute to
    Mrs X’s care costs. The Council arranged to pay this as a direct payment, starting on 13 September 2019, backdated to 16 August 2019.
36. At the end of September 2019 Mrs X’s family arranged for her to have two weeks in a care home. The family then arranged for Mrs X to stay there as a long term resident. Once resident in the care home she was no longer eligible for the direct payments.

Complaint handling

37. In early September 2019 Mrs W complained to the Council, mostly about delays in carrying out the financial assessments for Mrs X and Mr Y.
38. Three weeks later the Council asked Mrs W for consent from Mrs X, or from whoever held Lasting Power of Attorney (LPA) for her, to Mrs W making the complaint on her behalf. The Council also apologised for its delay contacting her.
39. In mid October 2019 Mrs W’s husband, Mr W, provided the LPA document which showed he had LPA for Mrs X. He said he would handle the complaint. The next day the Council allocated the complaint to a lead manager, Officer D, but did not confirm this to Mr W. Two weeks later, when Mr W asked if the complaint was being dealt with, the Council confirmed who was handling the complaint. The Council responded and apologised for its delay contacting the family to discuss a newly allocated complaint.
40. Officer D met the family in early November 2019. They discussed the terms of the complaint and what the family wanted. Officer D said she would send a resolution plan to the family within the next week. That did not happen and Mr W chased for the resolution plan three weeks later.
41. Once Officer D sent out the resolution plan, Mrs W pointed out some changes needed. Mrs W made it clear she wanted the Council to backdate direct payments for Mrs X to February 2019 when the Council first assessed her needs. She also wanted direct payments for Mr Y from his assessment in March 2019 until he died in August 2019. Officer D said she still intended to complete her investigation of the complaint by 20 December 2019.
42. The family agreed the resolution plan on 19 December 2019. Officer D completed her report on 24 December. The Council’s records suggest it emailed the report and covering letter to Mr W the same day. On 6 January 2020 Mrs W contacted the Council as she had not received the report and the Council emailed a further copy to her.
43. The report concluded:
• The Council should have been clearer in March 2019 Mrs X’s case would be closed and should have advised about the potential financial implications of the assessment not being completed.
• The Council would not backdate direct payments for Mrs X it was not clear what Mrs W’s eligible needs were between February and July 2019.
• The Council should have told Mrs Z of the potential for financial support from the Council had Mr Y’s assessment been completed.
• The Council would not backdate direct payments for Mr Y because it was not clear what, if any, needs should be met by the NHS and/or the Council. It was also because the family told the Council no formal support was needed.
• Information from Officer B’s assessment of Mrs X’s needs in February 2019 was stored securely. The second assessment in July 2019 was needed to ensure information about Mrs X’s needs were up to date.
• There was some miscommunication between the Council and the family in
  Mrs X’s case. The Council delayed carrying out Mrs X’s financial assessment between the end of June and beginning of September 2019 causing Mrs Z to chase it up.
• Communication between the Council and the family about Mr Y were effective and appropriate and the Council’s actions were led by what Mrs Z said.
44. The report recommended the Council apologise to Mrs W for not achieving the high standards of communication it would expect. It also recommended actions to ensure better communication by staff in future.
45. The Council’s covering letter apologised to Mrs W for the poor communication evidenced in the report.
46. The Council reports one recommendation has not yet been implemented. That recommendation was to remind all social work staff to discuss financial support with customers who are funding the cost of care privately.

Injustice to Mrs X and Mr Y

47. Throughout the period under investigation Mrs W is satisfied Mrs X and Mr Y had the support they needed from a privately paid personal assistant. Mrs W’s concern is that Mrs X and Mr Y were entitled to financial support from the Council, she asked for financial help and the Council delayed providing it. She says the family shielded Mrs X and Mr Y from any financial worries and any stress was caused to the family rather than Mrs X and Mr Y.

Findings

48. When she contacted the Council in January 2019, Mrs W was clear she wanted to know if Mrs X and Mr Y were entitled to financial support from the Council. The Council could only provide financial support if Mrs X and/or Mr Y had eligible needs the Council had to ensure were met. So the Council had to carry out needs assessments first.

Mrs X’s needs assessments and financial assessment

49. The Council started to assess Mrs X’s care needs in February 2019 but did not complete it. The failure to complete the assessment was fault by the Council. That led to delay in carrying out a financial assessment.
50. When Officer B went on extended leave the Council had no record of the officer’s assessment visit. That was fault by the Council. The Council tried to cover the officer’s caseload but, in Mrs X’s case, it did not do so thoroughly enough. Its actions were hampered by the lack of any record of the assessment visit. However, the Council did have Mrs W’s first request about whether Mrs X or
    Mr Y were entitled to financial support. The Council’s discussion with Mrs Z in March 2019 should have covered the fact that a financial assessment could not be carried out until the Council had completed an assessment of Mrs X’s eligible needs.
51. Had a thorough discussion taken place in March, it is more likely than not that the Council would have gone on to complete Mrs X’s care assessment. It is also likely the Council would have confirmed she had eligible needs and then carried out a financial assessment. The Council would have backdated the result of the financial assessment to February 2019.
52. After the Council assessed Mrs X’s needs in June 2019 it was at fault in failing to ensure it then carried out a financial assessment quickly enough. The Council’s delay carrying out the financial assessment until early September 2019 was further fault.
53. The Council’s faults caused Mrs X’s family to chase up action when they should not have had to. The faults also meant Mrs X paid the full costs of her care between February and August 2019 when she was entitled to financial support from the Council. The Council should now backdate its financial support for
    Mrs X.

Mr Y’s needs assessment and financial assessment

54. The Council assessed Mr Y’s needs separately from Mrs X’s and, in March 2019, it assessed he did have eligible needs. The assessment showed Mr Y’s family described his support as being from friends and family. The personal assistant was described as Mrs X’s formal support. When an officer checked with the family in April and June 2019 the family continued to say they did not want formal support for Mr Y. While the Council understood Mr Y did not receive paid support himself, there was no fault by the Council in not carrying out a financial assessment for Mr Y.

Complaint handling

55. Overall, the Council took four months to complete its complaints procedure. That is well within the only timescale set by the regulations. During the procedure there were some delays in acknowledging receipt of the complaint, confirming who the lead manager and sending the resolution plan to Mr and Mrs W for agreement.
56. The Council has already apologised for its delays within the procedure and those apologies are a sufficient remedy.

Agreed action

57. Within six weeks the Council will:
• calculate how much it would have paid Mrs X in direct payments for February – August 2019 had it completed its needs and financial assessments on time, then pay that amount to Mrs X; and
• complete the outstanding recommendation from the complaints procedure, to remind all social work staff to discuss financial support with customers who are funding the cost of care privately.

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Final decision

58. I have now completed my investigation because the Council’s agreed actions will remedy the injustice caused by its fault.

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Investigator's decision on behalf of the Ombudsman