Summary: Mrs C complains about poor communication from the Council in relation to care provision, failure to complete a carer assessment, inadequate care, delay setting up direct payments and implementing an increase in provision and failure to provide a suitable chair. The Council delayed telling Mrs C about the cost of the service, failed to ensure a handover took place, failed to complete a carer assessment and provided Mrs C with wrong information about the provision of the chair. Those failures did not affect the provision in place. An apology, payment to Mr D and reminder to officers is satisfactory remedy.

The complaint

1. The complainant whom I shall refer to as Mrs C, is represented by her son, Mr D. Mrs C complained about the way the Council dealt with her adult social care case. Mrs C complained:
• the first officer the Council allocated to work with her failed to communicate properly with her and Mr D;
• the first care provider commissioned by the Council was substandard and failed to provide the care she needed;
• the Council commissioned a second care agency without consultation when that was not required;
• the Council failed to complete a carer assessment for Mr D;
• the Council delayed implementing what had been agreed at a care review in February 2020;
• the Council delayed setting up direct payments;
• the Council failed to properly respond to her first complaint;
• the Council dealt with Mr D inappropriately and initially refused to provide help when her care agency gave 72 hours notice in October 2020; and
• the Council failed to provide a suitable chair following an occupational therapy referral in December 2020.
2. Mrs C says fault by the Council led to her and Mr D missing out on provision, caused them distress and led to them having to go to time and trouble to pursue the complaint.

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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. The Ombudsman cannot question whether a Council’s decision is right or wrong simply because Mrs C disagrees with it. He must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, sections 26(1) and 26A(1), as amended and 34(3))
4. 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

5. As part of the investigation, I have:
• considered the complaint, Mrs C's comments and the documentary evidence she provided;
• made enquiries of the Council and considered the comments and documents the Council provided.
6. Mrs C 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

What should have happened

7. The Council has issued practice guidance for undertaking a needs assessment and making an eligibility decision (the guidance). The guidance refers to the Care Act 2014 which says local authorities must carry out an assessment of anyone who appears to require care and support. The Council will carry out a needs assessment to determine eligibility and consider how the person can best be supported.
8. The guidance says the needs assessment should be service user led as far as possible. The guidance says the assessor should clearly explain the process and what happens next. Following the assessment the assessor should provide recommendations for any action required.
9. The guidance says based on the needs identified and the support planned the Council will create an indicative personal budget using the Council’s cost setting guidance. The guidance makes clear this is a rough guide only and is not always accurate. The guidance says the Council must send the service user a copy of their assessment and a statement of the indicative personal budget.
10. The Council’s direct payments policy (the policy) says when certain conditions are met all or part of the Council’s proportion of a personal budget can be paid direct to an adult with care and support needs instead of the Council arranging for services to meet those needs. The policy says it has a duty to offer direct payments to anyone who has been assessed as eligible for care and support as long as various conditions are met.
11. Where an individual provides or intends to provide care for another adult the local authority must consider whether to carry out a carers' assessment if it appears the carer may have any needs for support. Carers' assessments must seek to establish:
• the carer's need for support;
• the sustainability of the caring role itself including both practical and emotional support the carer provides to the adult.
12. The local authority must consider whether the carer is currently able and willing to continue to provide care for the adult needing support.

What happened

13. Mrs C was living with her son (Mr D), who is her representative, when she was admitted to hospital in 2019. Following her discharge from hospital Mrs C received a service from the re-ablement team.
14. Mrs C went back into hospital in November 2019. On discharge from hospital in December 2019 the Council completed a further assessment of Mrs C’s needs. This assessment identified Mrs C was unlikely to improve in her functioning and therefore re-ablement was no longer appropriate. Single-handed calls, twice daily was recommended. A care agency began providing care.
15. The Council asked Mrs C to complete a financial assessment form in December 2020. Mrs C provided some information in January 2020. Mr D returned the financial assessment form in February 2020, by which time the family had cancelled the care provider and intended to arrange for a private carer. The Council was still waiting for some financial information from Mrs C at that point.
16. Later in February Mr D asked the Council to carry out a further assessment as Mrs C’s care needs had increased. The Council contacted Mr D to get further details from him and he referred the officer to the private carer. The Council spoke to the private carer and agreed to complete an assessment.
17. The Council wrote to Mrs C on 18 February 2020 to tell her the approximate cost of the service assessed in December 2020, although that was for guidance only.
18. The Council carried out a further assessment on 19 February. Mr D asked for a direct payment and the Council agreed to commission a care package for Mrs C of three calls a day. The Council’s officer explained the setup of the direct payment scheme would take 6-8 weeks and suggested a managed care service in the meantime, which Mr D declined. Mr D said the family would continue with the private carer pending the direct payment being set up.
19. Although Mrs C declined the option of an interim managed service the Council wrongly arranged for a care provider to attend. Mrs C declined that service as she already had a carer in place.
20. The Council wrote to Mrs C in March 2020 to provide her with an outline of the cost of the service which was for guidance purposes only. The Council explained the financial assessment would determine how much she needed to pay.
21. The Council agreed a direct payment on 20 March. That was backdated to February 2020.
22. Mr D asked the Council about respite services in March 2020. The Council explained it would need to carry out a carer assessment before arranging any services.
23. On 23 October 2020 Mr D contacted the Council as the care provider had given 72 hours notice on the care package. The Council told Mr D as he had a direct payment and the contract was between him and the care agency he could contact another agency and ask it to take over the care package. Mr D told the Council he did not have time to do that and asked the Council to do that for him. The Council told Mr D to identify another agency and advise them of the situation. Mr D was not happy with that advice and ended the call. Later that day Mr D contacted the Council to advise he had only been able to find a new agency that charged more and he could not afford the top up. The Council discussed the case with him and Mr D agreed for the Council to arrange an interim managed care package and to suspend direct payments until he could source a preferred agency.
24. The Council carried out a further review in November 2020 which did not change the provision for Mrs C. At that review Mr D told the Council he did not consider himself a carer for Mrs C.
25. The Council received a referral for seating for Mrs C in January 2021. An occupational therapist visited and identified the need for a riser recliner chair. The Council placed an order. The equipment provider tried to contact Mr D but received no response. The equipment provider therefore cancelled the order. I understand Mrs C no longer needs the chair as she is now resident in a care home.

Analysis

26. Mr D says the Council provided a care plan but did not tell him about the cost of the service and delayed responding to his queries about that. Mr D says because he was concerned about the potential cost of the service he ended it in January 2020 as he had been unable to obtain details of the financial cost from the Council.
27. I cannot identify any evidence the Council told Mrs C or Mr D about the likely cost of the service between December 2019 and February 2020. While I would not expect the Council to be able to tell the family about the indicative cost immediately I would have expected the Council to follow up with the family promptly about that. I do not consider a two-month delay satisfactory and it is therefore fault. The delay undermined Mr D’s confidence in allowing the care to continue. I recommended the Council apologise for that delay and pay Mr D £100 to reflect the time and trouble he had to go to pursuing the complaint. The Council has agreed to my recommendation. I do not make any further recommendation for a financial remedy given Mr D subsequently raised concerns about the suitability of the care agency allocated. In those circumstances, on the balance of probability, even if the Council had provided the financial information earlier Mr D would still have ended the care package.
28. I recognise Mr D did not receive a final figure from the Council until 11 March 2020, after a review took place. I am satisfied though the Council was waiting for some financial information from Mrs C which it did not receive until the end of February 2020. I therefore do not consider the delay providing the final figure is fault.
29. Mr D says the Council did not tell them about direct payments or that they could choose their own carer when it completed the first assessment. Having considered the documentary evidence I am satisfied when the Council’s officer carried out the assessment in December 2019 he informed Mrs C and Mr D about the availability of direct payments, which they declined. I am also satisfied direct payments were discussed at the review visit in February 2020 given Mr D chose to pursue the direct payments option at that point. As I am satisfied direct payments were discussed with the family and initially declined and then accepted at a later review I have no grounds to criticise the Council.
30. Mr D says the first officer allocated to work with Mrs C wrongly told them he was a social worker when that is not accurate. I have found nothing in the records to suggest the officer that met with Mrs C and her family told them he was a social worker. It is also clear the officer’s job title was included on correspondence with Mrs C. I therefore have no grounds to criticise the Council.
31. I have found no evidence to support Mr D’s allegation the first officer allocated to the case avoided answering direct questions. That is because I have not found any evidence of questions being posed to that officer, other than in relation to the request for details of the cost of the service, which I cover earlier.
32. Mr D says the Council contacted the private carer he had arranged behind the family’s back following the review in February 2020. Mr D says the Council tried to pressurise the private carer by telling her it had agreed a 30 minute visit each morning which was not accurate. I will comment on the amount of time allocated to Mrs C’s care later in this statement. In terms of contact with the private carer, the only documentary evidence I have showing contact with the private carer is that which took place before the review assessment in February 2020. I am satisfied that contact took place at the request of Mr D, who provided the contact details for the carer. I have found no evidence to suggest the Council contacted the private carer following the review assessment. In those circumstances I have no grounds to criticise the Council.
33. Mr D says the Council failed to ensure handover between the re-ablement team and the first care provider in December 2019. The evidence I have seen satisfies me the Council asked the re-ablement team to complete the handover to the new care provider on 23 December 2019. I have seen no evidence though to suggest the Council knew a handover had not taken place until it was contacted by the family in January 2020. Failure to ensure the handover took place is fault. It is clear Mr D’s view is that it is failure to handover the case properly which affected the provision Mrs C received from the first care provider. However, the evidence I have seen satisfies me Mr D ended the care package at least partly due to concerns about the cost. I am therefore not convinced if a handover had taken place the outcome would have been different. In those circumstances I recommended the Council apologise to Mrs C for the failure to ensure a handover took place between the re-ablement team and the first care provider. The Council has agreed to my recommendation.
34. Mr D says the Council delayed referring Mrs C for a direct payment between December 2019 and March 2020. Having considered the documentary evidence I have not identified any request from Mr D for direct payments until February 2020. Rather, the documentary evidence shows at the assessment in December 2019 Mr D advised the Council they would contact it at a later date if they wanted to pursue direct payments. As I am satisfied the Council made the referral promptly after the request in February 2020, backdated the direct payment to February 2020 and offered an interim service while the direct payment was processed I have no grounds to criticise it.
35. Mr D says the Council misrepresented the direct payment scheme by suggesting it was complicated and onerous. Mr D also says the first officer dealing with the case told him the standard of care he was expecting was out of the family’s price range. While I am satisfied the documentary evidence shows the Council discussed the availability of direct payments with Mrs C at the first assessment in December 2019 I do not have a record of the exact information given to the family. I therefore cannot reach a safe conclusion about what the Council’s officer said about the direct payment process.
36. Mr D says the Council commissioned a second care agency in February 2020 without consulting the family and when it was not required. The evidence I have seen satisfies me when the Council carried out the review assessment in February 2020 the family made clear they did not want to access an interim care service from the Council while it set up direct payments. The evidence shows instead the family made clear they would continue to use the private carer. In those circumstances the Council was at fault for arranging a care agency to visit. The Council accepts that. I consider an apology a satisfactory outcome for this part of the complaint.
37. Other than in relation to the arrangement for a second care agency which was not required I have found no evidence to suggest the Council made decisions on Mrs C’s case without consulting her or her family.
38. Mr D says the Council contacted the care provider he had employed to provide care to Mrs C under direct payments without consulting him. Mr D says the hospital social worker cancelled the contract with the care agency and tried to replace it with a different agency which delayed Mrs C’s discharge from hospital and put pressure on them. The Council has no records of any contact with the care provider Mrs C employed. I therefore have no grounds to criticise it.
39. Mr D says the Council failed to deal with the concerns they raised about the care provider that began providing care in December 2019. Mr D says the carers from the care provider visited at inconsistent times, rushed tasks, did not stay the full 30 minutes and did not provide adequate care. Having considered the documentary evidence I have found no evidence to suggest Mr D raised any specific concerns with the Council when cancelling the care package. While I am aware Mr D referred to concerns about the care provider later in 2020 I have seen no evidence he provided detail about those concerns which would have enabled the Council to investigate. In those circumstances I have no grounds to criticise the Council.
40. Mr D says the Council failed to complete a carer’s assessment. Having considered the assessment completed in December 2019 I note it records Mrs C does not have a carer. I therefore do not criticise the Council for not carrying out a carers assessment in November 2019. The assessment in December 2019 contrasts to the February 2020 assessment which records Mr D is her carer. That February 2020 assessment recorded Mr D had asked for information about respite support for carers. I am satisfied the outcome of that assessment was for the Council to complete a carers assessment. I have found no evidence the Council did that. That is fault.
41. At that point though the country was in lockdown due to Covid 19 and therefore I consider it unlikely the Council would have been able to put in place respite arrangements. I therefore consider it unlikely Mrs C or Mr D missed out on any provision during the lockdown period. I also note that by November 2020 Mr D had made clear he did not consider himself Mrs C’s carer and was only providing Mrs C with emotional support and help with her finances and shopping. In those circumstances although I consider the Council at fault for not carrying out a carers assessment as it agreed to do in February 2020, I consider it unlikely this meant Mr D missed out on any provision. I therefore do not intend to pursue the point further.
42. Mr D says the Council delayed implementing the three care visits following the February 2020 review. Mr D says this means Mrs C missed out on provision. Having considered the documentation for the February 2020 review it is clear there is some confusion about the length of the AM call agreed as both 45 minutes and 60 minutes are referred to. The Council’s documentation refers to the 45 minute AM call being increased to 60 minutes following the occupational therapist’s moving and handling assessment in March 2020. However, I have not received any documentary evidence showing such an assessment recommending 60 minutes in March 2020. Given the records are confused about the length of time agreed for the AM call I cannot reach a safe conclusion about whether 45 minutes or 60 minutes was agreed at the review in February 2020.
43. I recognise though there was delay putting in place the third visit while discussions about the length of the morning visit took place. At that point though Mr D was arranging for a carer to provide support to Mrs C, pending the Council confirming the direct payment. I therefore do not consider the Council was responsible for increasing the number of care visits at that point. I am, however, satisfied the Council offered to make arrangements for interim provision while the direct payment process was completed, which Mrs C declined. As I said earlier, I am satisfied the direct payment was processed properly and backdated to February 2020. In those circumstances I cannot criticise the Council for any failure to increase the care visits to three per day given it was not responsible for providing care at that point.
44. I have found no evidence to support Mr D’s allegation delay by the Council setting up direct payments meant he could not identify a suitable care agency until 12 months after Mrs C began receiving services. As I said earlier, there is no evidence Mr D asked for direct payments before February 2020. It is also clear that despite this Mr D had identified his own private carer for Mrs C before the direct payments package began. So, I could not say fault by the Council led to a delay in Mr D identifying a suitable care agency.
45. Mr D says the Council failed to properly respond to his first complaint. Mr D says the response was dismissive and provided no assurances on when Mrs C’s needs would be met. Mr D is referring here to the Council’s complaint response of 19 March 2020. Having considered that response I do not consider it is dismissive. I am satisfied the response set out that the Council was arranging a direct payment for Mrs C so she could employ her own choice of carers. I appreciate the letter did not tell Mrs C when that process would be completed but I am satisfied the information the Council gave at an earlier stage made clear the process of setting up the direct payment normally took between 6-8 weeks and this was why the Council normally offered an interim service, which Mrs C had declined. As I have found no evidence of fault in how the Council responded to the complaint I have no grounds to criticise it.
46. Mr D says the Council initially refused to provide him with any help when the care agency gave notice on Mrs C’s care package with only 72 hours notice in October 2020. At that point Mrs C received a direct payment for her care. What this means is that Mrs C, rather than the Council, was responsible for managing the care provision. In those circumstances when the care provider withdrew it was not fault for the Council to tell Mr D because he had a direct payment and the contract was therefore between him/Mrs C and the care agency he should identify another agency to take over the care. I am, however, satisfied once Mr D made clear he could not do that the Council stepped in by contacting the existing care agency and identifying a new care agency to take over. There is no fault in how the Council dealt with this matter given Mrs C received a direct payment for her care at that point.
47. Mr D says the Council failed to provide a suitable chair following an occupational therapy referral and instead said the chair had been provided when it had not. The documentary evidence I have seen satisfies me the occupational therapist ordered the chair following her visit in February 2021. The Council says the reason the chair was not delivered is because Mr D failed to respond to contact from either the occupational therapist or the equipment provider to arrange delivery. In contrast Mr D says he did not receive any contact from either the equipment provider or the occupational therapist to arrange delivery of the chair. The Council has provided some documentary records showing the equipment provider’s attempts to arrange delivery with Mrs C. However, the mobile number the equipment provider states as being contacted is different to the mobile number Mr D provided the Ombudsman with. It is therefore possible the equipment provider did not have Mr D’s up to date number. As there is evidence the equipment provider tried to arrange to deliver the chair though there are no grounds on which I could criticise the Council in terms of the delivery of the chair.
48. The Council accepts though that when responding to Mr D’s complaint it incorrectly said the chair had been delivered. Including incorrect information in the Council’s complaint response is fault. I recommended the Council apologise for that. The Council has agreed to my recommendation. I would also have recommended the Council liaise with Mr D to see whether a chair was still required given there appears to be an issue with the telephone number the equipment provider had for Mr D. However, I understand Mrs C is now resident in a care home and therefore the need for a chair is no longer required.

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Agreed action

49. Within one month of my decision the Council should:
• apologise to Mrs C and Mr D for the injustice caused by the faults identified in this statement;
• pay Mr D £100; and
• send a reminder to officers that handovers need to take place between carer agencies and a carer assessment must be completed when a carer asks for one.

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Final decision

50. I have completed my investigation and found fault by the Council in part of the complaint which caused an injustice to Mrs C and Mr D. I am satisfied the action the Council will take is sufficient to remedy that injustice.

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Investigator's decision on behalf of the Ombudsman