Summary: Mr B complained the Council delayed meeting his daughters’ assessed needs under the Care Act 2014. He says the Council delayed providing additional support after his daughters stopped attending college. We find the Council was at fault as it delayed responding to Mr B’s requests for additional support. The Council has agreed to our recommendations to address the injustice caused.

The complaint

1. Mr B complained the Council delayed meeting his daughters’ assessed needs under the Care Act 2014. He says the Council delayed providing additional support after his daughters stopped attending college.
2. Mr B says the Council’s failure to meet his daughters’ needs has resulted in unnecessary stress and mental health issues for the whole family. He says he had to overspend on the direct payments package which resulted in additional financial hardship.

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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. We may investigate complaints from a person affected by the matter in the complaint, or from someone the person has authorised in writing to act for him or her. If the person has died or cannot authorise someone to act, we may investigate a complaint from a personal representative or from someone we consider suitable to represent the person affected. (section 26A or 34C, Local Government Act 1974)
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 considered information Mr B submitted with his complaint. I made written enquiries of the Council and considered information it sent in response.
7. Mr B 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

Relevant legislation and guidance

8. Sections 9 and 10 of the Care Act 2014 require local authorities to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to all people regardless of their finances or whether the local authority thinks an individual has eligible needs. The assessment must be of the adult’s needs and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved.
9. Local authorities must carry out the assessment over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Local authorities should tell the individual when their assessment will take place and keep the person informed throughout the assessment.
10. Where an individual provides or intends to provide care for another adult and it appears the carer may have any needs for support, local authorities must carry out a carer’s assessment. Carers’ assessments must seek to find out not only the carer’s needs for support, but also the sustainability of the caring role itself. This includes the practical and emotional support the carer provides to the adult.
11. Direct payments are monetary payments made to individuals who ask for one to meet some or all of their eligible care and support needs. They provide independence, choice, and control by enabling people to arrange their own care and support to meet their eligible needs. The local authority has a key role in ensuring that people have relevant and timely information about direct payments so they can decide whether to request them.

What happened

12. Mr B’s twin daughters (Miss C and Miss D) have complex needs. The Council assessed them as having eligible care and support needs and set up two care packages through direct payments. This consisted of 28 hours a week of personal care, 13 nights of respite support for 10 hours a night and one-to-one day care support for 14 weeks a year. The day care support was for during the holidays when Miss C and Miss D were not attending college.
13. In January 2020, the community nurse contacted the Council. He asked for a social worker to be assigned to Miss C’s and Miss D’s files to plan for daily support because the college they were attending advised it was no longer suitable for them.
14. Mr B emailed the Council on 6 March. He said he needed help and an assessment from a social worker to identify a suitable college or day centre for Miss C and Miss D. The Council did not respond to this email.
15. An officer from the Council’s education department contacted the Council’s adult social care department in July and asked if a social worker had been allocated to Miss C’s and Miss D’s files. She also asked if some information could be provided to the family for suitable social care provision. An officer responded and said the Council had not allocated a social worker. She said Mr B would need to call and discuss the issues.
16. Mr B emailed the Council on 3 August and said he wanted a social worker to assess Miss C’s and Miss D’s needs because they were no longer attending college. The Council called Mr B on 6 August but did not receive a response.
17. Mr B sent a further email on 26 August and asked for the Council to review Miss C’s and Miss D’s care packages. He said more support was required for them to access community activities.
18. The Council assigned a social worker (Social Worker A) to Miss C’s case on 28 August. The Council assigned Social Worker A to Miss D’s case on 10 September.
19. The Council assessed Miss C on 24 September and Miss D on 1 October. Social Worker A recognised that Miss C and Miss D would benefit from having extra support to engage in activities indoors and in the community.
20. Social Worker A presented the cases to the resource allocation meeting on 22 October and asked for extra funding for social stimulation and day services. The panel asked Social Worker A to complete a carer’s assessment and explore the existing direct payments packages. They also requested for an occupational therapist (OT) to complete functional assessments.
21. The OT completed her initial assessments on 7 December. She said she would arrange a home visit to complete the functional assessments.
22. Mr B raised a formal complaint on 18 December. He said the Council had not provided him with any additional support. He also said he had been providing round the clock care without any rest.
23. Social worker A completed a carer’s assessment for Mr B on 7 January 2021. Mr B explained it was difficult for him to engage Miss C and Miss D in meaningful day activities at home without further support.
24. The OT was redeployed to work in a hospital because of the COVID-19 pandemic. There was therefore a delay in completing the functional assessments. As the Council was aware Mr B was struggling, it agreed for Social Worker A to return to the panel and present it with the OT’s initial assessments and the carer’s assessment.
25. Social Worker A presented the cases to the panel on 21 January. The panel asked Social Worker A to complete an NHS Continuing Healthcare (CHC) checklist and make a referral for a full assessment. The assessment would determine whether Miss C and Miss D were eligible for full CHC funding. CHC is a package of care for adults which is arranged and funded solely by the NHS. The panel also said the OT needed to complete the functional assessments.
26. The Council responded to Mr B’s complaint on 11 February. It said it did not uphold his complaint because it was taking steps to decide whether Miss C and Miss D needed additional support.
27. The OT completed her assessments on 16 and 22 February. She recommended that Miss C and Miss D would benefit from attending day services regularly.
28. Social Worker A completed the CHC checklist on 24 February. He sent it to the Clinical Commissioning Group (CCG) on 21 April. CCGs are groups of general practices which come together in each area to commission services for their patients. The Council’s case notes state it needed to reallocate the cases as Social Worker A was leaving.
29. The OT emailed the Council on 1 June and asked if the Council had allocated a social worker to progress matters. The Council allocated a new social worker (Social Worker B) on 10 June.
30. Social Worker B arranged an assessment with Mr B for 18 June. Mr B said an assessment was not necessary as Social Worker A had already completed a CHC assessment in February.
31. Social Worker B emailed the CCG team on 29 June and asked for a meeting. A member of staff responded and said she would need to complete CHC consent forms for Miss C and Miss D.
32. Social Worker B completed a further review and a CHC assessment on 11 August. She noted the care packages were longer meeting Miss C’s and Miss D’s needs and they needed to attend a day centre so they could engage in social and brain stimulation activities.
33. The Council agreed funding for Miss C and Miss D to attend a day centre for five days a week on 1 September. It also agreed to increase the personal care packages to 40 hours each per week.

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Analysis

34. The Council missed opportunities to review Miss C’s and Miss D’s care packages much sooner. This is fault. It was aware at the end of January 2020 the college and Miss C and Miss D were attending was no longer appropriate for them and therefore a social worker needed to review matters. Mr B also emailed the Council in March 2020 and asked for help. The Council only started to act after further prompting from Mr B in August 2020.
35. The OT completed her assessments by 22 February 2021 and Social Worker A completed the CHC checklist on 24 February 2021. Despite this, there was a two-month delay before Social Worker A sent the CHC checklist to the CCG. The Council said in April 2021 it would allocate a new social worker to Miss C’s and Miss D’s case. It only did so in June 2021 after prompting from the OT. This meant the Council allowed the cases to drift. The Council knew Mr B, Miss C and Miss D had been waiting for a long time and so it should have been acting much quicker.
36. The Council’s faults have caused Mr B, Miss C and Miss D a significant injustice. Mr B has suffered mental and physical distress because he had to take on extra caring responsibilities while Miss C and Miss D were spending more time at home. I also note Mr B says he has been unable to work and enjoy a social life. Miss C and Miss D also suffered because they lost out on provision that was required to meet their needs. The Council needs to remedy this injustice.
37. Mr B says he had to overspend on the direct payments package. This was to allow Miss C and Miss D to attend a day centre once a week from February 2021 while he was waiting for the Council to approve the funding. I have seen no evidence of overspending. The Council allowed Mr B to use the direct payments flexibly and pay for the day centre out of the existing packages while he was waiting for the increased funding to be approved.

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Agreed action

38. To address the injustice caused by fault, by 25 February 2022 the Council has agreed to:

• Apologise to Mr B, Miss C and Miss D.
• Pay Mr B £800 which reflects his avoidable time and trouble and the upset and frustration he has been caused.
• Pay Miss C and Miss D £650 each for the distress and upset caused by provision they lost out on.
• Issue written reminders to relevant staff to ensure they must act in a timely manner when a service user or their representative asks for a review of their care and support needs.

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Final decision

39. I have found fault by the Council, which has caused an injustice. The Council has agreed to my recommendations and so I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman