Summary: The Council failed to properly assess the impact of reducing Mr X’s care package. This put his health and wellbeing at risk and led to a loss of care provision for almost a year. It also caused him distress, uncertainty and time and trouble. The Council has agreed to pay Mr X £1,600 to acknowledge the avoidable injustice caused by these faults and has committed to making our recommended service improvements.

The complaint

1. Mr X complained the Council failed to properly assess his care needs when it reduced his care package, putting him at risk and impacting his health and wellbeing. This caused him distress, uncertainty and time and trouble.

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The Ombudsman’s role and powers

2. 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)
3. 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/care provider has done. (Local Government Act 1974, sections 26B and 34D, as amended)
4. I have investigated the Council's June 2020 review of Mr X's care needs. Mr X did not complain to us about this review within twelve months of it coming to his attention. However this review was the first to significantly alter Mr X's care hours and is linked to the October 2020 review. I cannot properly investigate the October 2020 review without looking at both, so I have decided there are good reasons for us to investigate.
5. 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)
6. Under our information sharing agreement, we will share this decision with the Care Quality Commission.

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How I considered this complaint

7. I considered the information provided by Mr X's representative and the Council.
8. I considered the relevant law and guidance as set out below.
9. I considered our Guidance on Remedies.
10. I considered comments made by Mr X and the Council before making a final decision.

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Law and guidance

Care assessments

11. Sections 9 and 10 of the Care Act 2014 require councils to carry out an assessment for any adult with an appearance of need for care and support.
12. The assessment must be of the adult's needs and how they impact on their wellbeing 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.
13. To be eligible for care and support assistance the adult should be unable to achieve at least two of the specified outcomes below. These include but are not limited to:
• managing and maintaining nutrition;
• maintaining personal hygiene;
• managing toilet needs;
• being appropriately clothed;
• being able to make use of the adult's home safely; and
• maintaining a habitable home environment.

Care and support plans

14. If a council decides a person is eligible for care, it should prepare a care and support plan which specifies the needs identified in the assessment. It should say whether and to what extent the needs meet the eligibility criteria, specify the needs the council is going to meet and outline how this will be done. The council should give a copy of the care and support plan to the person. (Care Act 2014, sections 24 and 25)

Reviews of care and support plans

15. The Care and Support Statutory Guidance (Statutory Guidance), Section 13, says:
• care plans should be reviewed at least annually;
• reviews should identify if the adult's needs have changed and a reassessment is needed;
• when reviewing the care plan, councils should follow safeguarding principles to ensure the person is not at risk of abuse or neglect; and
• periodic reviews must not be used to arbitrarily reduce a care and support package.
16. Section 27 of the Care Act 2014, 'Review of Care and Support Plan', says,

'Where the local authority is proposing to change how it meets the person's needs, it must take all reasonable steps to reach agreement with the adult concerned about how it should meet those needs.'

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What I found

Background

17. Mr X has a spinal cord injury and is a wheelchair user.
18. He has a care plan and until March 2020, had 13 hours of care at home a week which enabled him to meet his eligible needs.
19. His assessments during the period covered by this investigation regularly highlighted that his mental health was at risk of deteriorating. This was exacerbated by isolation during the pandemic.

June 2020 assessment – recommends 3.5 care hours

20. In March 2020, at the beginning of the pandemic, Mr X's carer resigned and Mr X informed the Council he was no longer receiving his required hours of care.
21. Due to Mr X's concerns about catching COVID-19 from carers attending his home, Mr X agreed to a review of his care needs to see if changes could be made to help him manage some domestic tasks without carers. This was carried out by the Council's 'Enablement at Home' team.
22. The Council began the process of assessing Mr X in April 2020 and the final review was sent to him in June 2020. This recommended that his eligible needs could be met with 3.5 hours of care per week instead of the 13 hours per week he had previously.
23. This review failed to assess him against his eligible needs under the Care Act and failed to properly explain how his eligible needs would continue to be met.
24. Mr X said he found the assessment process intrusive and did not agree with the assessment. The Council says Mr X then stopped engaging with the process. Mr X says he had to stop engaging because he was experiencing a mental health crisis.
25. A period of two months passed where Mr X was without the care he needed and the Council was aware of this. During this time Mr X only had a neighbour helping him with his food shopping.
26. Although at the beginning, this was partly by choice due to Mr X's concerns around catching COVID-19, the Council accepted that once Mr X disputed the care hours offered, it did not do enough to reach agreement with Mr X or follow up his lack of response.

October 2020 assessment – recommends 7 care hours

27. Mr X enlisted an advocate to represent him. His advocate made a referral to the Council's Adult Social Care team in August 2020 alerting it to the fact Mr X was without adequate care following the June assessment.
28. It then took the Council a further two months before a new care assessment was carried out. Mr X was supported during this assessment by his advocate.
29. This assessment identified that Mr X had four eligible care needs which he required care and support to meet:
• maintaining personal hygiene;
• being able to make use of the home safely;
• managing and maintaining nutrition; and
• maintaining a habitable home environment.
30. This time the Council recommended that Mr X's care needs could be met with 7 hours of care a week.
31. This assessment referred to Mr X's eligible needs but did not properly explain how the needs would be met with these hours, which were increased by 3.5 hours per week from the last review but still amounted to almost half of the care hours he was receiving eight months earlier.
32. The Council also stated in this review that the council does not pay 'solely for a cleaner', despite Mr X having an eligible need for support with cleaning.
33. Mr X disagreed with this assessment and remained without his necessary care until he arranged some care himself in December 2020.

July 2021 assessment (currently in place) – recommends 8.5 care hours

34. Mr X's most recent care needs assessment increased his care hours from 7 hours to 8.5 hours per week. This care plan was accepted by Mr X but his advocate told us Mr X only accepted these hours as he feared another period without any care in place. Mr X said he struggles to meet his needs with these 8.5 hours.
35. In this review, Mr X's eligible care needs are the same as in previous assessments. It is again not clearly set out in this assessment how these eligible needs can be met with 8.5 hours.
36. Regarding Mr X making use of his home safely and managing and maintaining nutrition, the assessment refers to an occupational therapist 'looking at kitchen adaptations'. However, these adaptations were not yet in place and the Council did not explain how the eligible need would be met with reduced care hours in the meantime.

Access to hot meals

37. The Council highlighted in all assessments in this period that Mr X cannot access hot meals at weekends on the current care plan. The assessments all recommend he use a hot meals service but add that Mr X has declined this option as it is too expensive.
38. It is raised several times in Council correspondence and the assessments that Mr X has burnt himself in the past trying to prepare and carry hot food and the injuries were exacerbated by lack of sensation due to his spinal cord injury.
39. The Council was aware during all three assessments in this period, that Mr X could not access daily hot meals. However, none of the assessments demonstrate that the Council looked into Mr X's finances and the affordability of using a hot meal service.

Overall impact on Mr X

40. During the period when Mr X's care hours were reduced, his advocate informed us he struggled to maintain a habitable home and did not have regular access to hot meals which are important due to his disability.
41. His advocate said he also experienced a lack of socialisation during this time as he had much reduced care hours, against the backdrop of the COVID-19 pandemic.
42. We can see from the records that Mr X experienced a mental health crisis in March 2021 as it caused him to be unable to attend a planned care assessment meeting. Mr X had been experiencing mental health problems since March 2020 when his carer resigned.

My findings

Failure to safeguard Mr X’s health and wellbeing

43. The Council has accepted that when Mr X stopped engaging with the Council in June 2020, after it reduced his care hours, the Council did not fully consider the risks of him being without the care he needed during the period of dispute.
44. The Council also accepted it was not 'tenacious enough' in following up with Mr X when he stopped responding to the Council.
45. Mr X said this made him feel the Council did not care about his need for proper nutrition and a habitable home environment. This was fault leading to avoidable distress and anxiety for Mr X for a period of several months.

Failure to properly consider eligible needs during care plan reviews

46. The Council's reviews of Mr X's care and support needs in June 2020, October 2020 and July 2021 all failed to properly set out how his eligible needs would be met with a reduced care package.
47. Failure to do so was a breach of the Care Act and this was fault. This fault caused Mr X significant distress over a period of several months. It also cost him avoidable time and trouble in challenging the decisions.

Refusal to pay for a cleaner

48. The Council said in the assessment the Council 'will not pay solely for a cleaner'. This is not Council policy. It also would not be in line with the Care Act for the Council to have a policy of blanket refusal to pay for a cleaner if this would meet someone's eligible need.
49. It is not clear why the assessor believed this was Council policy and this belief may have prevented Mr X from accessing care and support that he needed.
50. It is not for the Ombudsman to say whether a cleaner would have been the right solution to meet some of Mr X's eligible needs. This decision was for the professional involved. However, the Council's blanket refusal in this case to consider the option was fault leading to avoidable uncertainty for Mr X.

Loss of provision of care

51. Mr X's June 2020, October 2020 and July 2021 assessments were flawed. Therefore, we cannot know for certain what care hours are currently suitable for Mr X and it is not for the Ombudsman to instruct professionals on the number of care hours an adult requires.
52. However, on the balance of probabilities, as the assessments do not show a significant change in Mr X's needs during the period in question, it is likely that since June 2020, Mr X should have been receiving at least 8.5 hours of care a week. This is the amount of care hours currently in place.
53. The Council offered Mr X care packages which likely fell short of this amount of care hours between June 2020 and July 2021. This was fault leading to a loss of provision for Mr X.

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Agreed actions

54. Within one month of the date of the final decision, the Council has agreed to;
• apologise to Mr X for failing to properly consider his eligible care needs during his June 2020, October 2020 and July 2021 care assessments;
• with Mr X's consent, carry out a fresh review of his care plan, with a different social care professional, which sets out in detail how his eligible needs under the Care Act will be met; and
• pay Mr X £1,600 in recognition of the lost care, risk of harm, distress, anxiety, uncertainty and time and trouble he was caused because of faults in this case, at a time when he was already suffering with his mental health during the pandemic.
55. Within three months of the date of the final decision, the Council has agreed to demonstrate that it has;
• reminded staff of the importance of continuing to ensure the adult's care needs are being met when their care plan is under review, particularly if they are without adequate care during a period of dispute;
• reminded staff that its policy allows for the provision of cleaners to people with eligible needs under the Care Act;
• reminded staff of the Council's duty to clearly set out how a person's eligible care needs will be met, particularly where it proposes to reduce someone's care hours; and
• reminded staff of the importance of considering the person's financial position when recommending the use of a hot meal service.

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Final decision

56. I have completed my investigation. I have found fault leading to significant personal injustice and have recommended a financial remedy and service improvements.

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Investigator's decision on behalf of the Ombudsman