Summary: Miss G complains the Council has failed to meet her assessed eligible care needs and carry out her needed home adaptations due to her health needs. We found the Council seriously delayed in carrying out a financial assessment to determine if Miss G needed to contribute to her care package. This in turn delayed the necessary care and support Miss G needed. In addition, the Council sent Miss G incorrect documentation relating to her application for a disabled facilities grant which caused uncertainty and a delay to her needed home alterations. That said, we found Miss G has also been unavailable for appointments and professional visits which also delayed her needed home alterations. Nevertheless, the fault identified has caused Miss G an injustice and the Council has agreed to our recommendations to remedy this.

The complaint

1. The complainant, who I refer to as Miss G, complains the Council has not arranged care and support for her since applying for this in the year 2019. Further, she is dissatisfied that the Council has not completed home adaptions which are needed due her disabilities. Miss G says the Council has unreasonably delayed providing her the care and support she needs.
2. As a result, Miss G explains she is being left without care and support which is causing her extreme distress and anxiety. As a desired outcome, Miss G wants the Council to make immediate provision of her care package and bathroom adaptations without further administrative work.

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The Ombudsman’s role and powers

3. The Local Government Act 1974 sets out our powers but also imposes restrictions on what we can investigate.
4. 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)

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How I considered this complaint

5. I have read Miss G’s complaint to the Ombudsman and Council. I have also had regard to the responses of the Council, supporting documents and applicable legislation and statutory guidance. I invited both Miss G and the Council to comment on a draft of my decision. All comments received were fully considered before a final decision was made in this case.

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My findings

Background and legislative framework

The Care Act 2014

6. Some people need extra care or support, practical or emotional, to lead an active life. The need for social care may arise when a person becomes frailer with age as one example. A care and support plan is a detailed document setting out what services will be provided by the local authority. It also explains how it will meet the person’s needs, when they will be provided, and who will provide them. A care and support plan should be reviewed regularly by the local authority.
7. In circumstances where an adult may have needs for care and support, Section 9 of the Care Act 2014 places a duty on local authorities to conduct a needs assessment. This is to determine whether the adult does have needs for care and support and if the adult does, what those needs are. Once a needs assessment has been completed, the Care and Support (Eligibility Criteria) Regulations 2014 is used to identify the level of needs which must be met by a local authority. Where a local authority has determined a person has eligible needs, it has a legal duty to meet these needs, subject to meeting the financial criteria.
8. The Care and Support Statutory Guidance says that an assessment should be carried out over an appropriate and reasonable timescale.

Disabled facilities Grant

9. Disabled Facilities Grants are provided under the terms of the Housing Grants, Construction and Regeneration Act 1996. Councils have a statutory duty to give grant aid to disabled people for certain adaptations. Before approving a grant, a council must be satisfied the work is necessary, meets the disabled person’s needs, and is reasonable and practicable.
10. Social care authorities must promote ‘wellbeing’ when carrying out care and support functions. Wellbeing includes the suitability of living accommodation. The Care Act 2014 recognises suitable accommodation as one way of meeting care and support needs. Prevention is critical to the Care Act and home adaptation is an example of secondary prevention.
11. The maximum grant payable by a council is £30,000. A council can award other discretionary help if it thinks it is necessary. The council grant amount is subject to a means test. The test does not apply to applications from landlords, or from parents for grants for their disabled children. Regardless of who makes the application, the means test applies to the disabled person (the ‘relevant person’). If the relevant person has a partner, their finances are assessed jointly.
12. A council should decide a grant application as soon as reasonably practicable. This must be within six months of the application. If a council refuses a grant, it must explain why. Once the work is complete, the council must pay the grant in full within 12 months of the application date.

Independent Living Grant

13. These grants enable adaptations to a home, which assist with independent living, but add no value to a property, such as stair lifts and level access showers. It can assist with keeping a resident safe at home and allow a faster discharge from hospital. It can provide funding to repair and replace inefficient heating systems to prevent worsening an existing medical condition, that may result in an unnecessary hospital admission. The application must be supported by an Occupational Therapist or Trusted Assessor, or similar competent person. There is no means test for this grant and there are no repayment conditions

Chronology of events

14. In June 2019, Miss G requested a care assessment from the Council to inform any measures of support it could offer her.
15. In October 2019, Miss G was visited at home by a social care assistant from the Council to assess her care needs. Following this visit, Miss G requested that a financial assessment be completed before she decided whether she wanted to move forward with an assessment of her care and support needs.
16. In November 2019, the Council sent Miss G a financial assessment form. In accordance with Miss G’s wishes, the assessment for care and support was placed on hold pending the outcome of the financial assessment.
17. In mid-December 2019, the Council contacted Miss G to ascertain whether she had completed the financial assessment form. It was recorded that Miss G said she had not yet completed the form because she was waiting the outcome of her personal independent payment (PIP) application. At this stage, Miss G said she remained unsure whether she wanted care and support services.
18. In late December 2019, Miss G telephoned the Council to confirm she had completed the financial assessment form and requested someone from the Council collect this. The Council gave Miss G an email address to send the form electronically. Moreover, it is recorded that Miss G said she would still like to wait for the outcome of the financial assessment before deciding whether she wanted the Council to provide the assessed care and support package.
19. In February 2020, the Council received Miss G’s completed financial assessment form. However, the Council says this was only partially completed because it did not contain needed documents. Further, the Council told me the form was sent to the wrong internal team which meant it was not acted on upon immediately.
20. In March 2020, Miss G contacted the Council to inform that she had sent the financial assessment form to its offices, yet she has not received a reply. The Council noted there had been a delay with the financial assessment.
21. In April 2020, the Council noted that the financial assessment documentation had not been followed up correctly in order for further information to be gathered, particularly in relation to income of benefits. The Council apologised to Miss G for the delay and told her that it would contact the Department for Work and Pensions (DWP) to obtain the information.
22. In late April 2020, the Council determined that Miss G would not need to contribute towards her care and support based on the information available. The Council told me it intended to send Miss G a letter to this effect, but due to human error it was not sent until January 2022.
23. In mid-June 2020, the Council’s case notes record that Miss G declined Council support in the home to assist her personal care and provide domestic help. These also record that Miss G stated her preference to support herself and she was advised she could refer back to the care service if she changed her mind. The same month, the Council added Miss G to a waiting list to be assessed by an Occupational Therapist (OT) to inform any needed home adaptations.
24. In July 2020, Miss G’s sister-in-law contacted the Council to complain about the length of time it was taking to provide a package of care. The Council said this was due to Miss G declining the care and support offered. However, Miss G’s sister-in-law clarified that while Miss G did not want help relating to personal care (such as bathing and dressing), she would like help in supporting her domestically within the home. Miss G also confirmed this misunderstanding to the Council.
25. The Council responded to explain that it could arrange the social care support on the information already collected, but it needed to know how Miss G would like the service to be delivered. The Council said this could be either a directly commissioned service from the Council or through a Direct Payment. Miss G did not confirm how she wanted the service to be provided.
26. There was subsequently a number of attempts to visit Miss G and with respect to her package of care and OT visit. However, the records show visits and calls to Miss G were unsuccessful. During this period, Miss G did not confirm how she wanted the care and support package to be delivered.
27. In mid-June 2021, the Council’s OT sought to arrange a visit to Miss G’s property to undertake an assessment of her needs to inform any possible home adaptations. However, Miss G told the Council she wanted her application for home adaptions to be placed on hold. This is because she did not feel comfortable with home visitors during the Covid-19 pandemic.
28. In July 2021, Miss G contacted the Council to say she felt comfortable to receive home visitors. She therefore considered her application for home adaptations could now be progressed, following a visit from the OT to assess her needs.
29. In August 2021, the Council completed a further assessment to inform Miss G’s care and support needs. The Council subsequently offered a package of care and support and Miss G requested receiving a Direct Payment. The case notes record that Miss G was offered a Council commissioned service as an interim measure, though she stated her preference was to wait for this to be approved.
30. In September 2021, Miss G was offered an appointment by the OT for a home visit. However, Miss G was unable to undertake the appointment due to feeling unwell. She requested another appointment day as an alternative.
31. In October 2021, the planned visit by the Council’s OT to carry out the assessment did not go ahead. This was due to an error on the OT’s part which she apologised to Miss G for. However, the OT gave Miss G a number of alternative dates in November 2021 in order to carry out the assessment. The same month, the Council completed an updated care and support plan for Miss G which set out a package of care she was eligible to receive.
32. In late November 2021, Miss G responded to the OT apologising for the delay in responding which she said was due to have a number of recent falls. The OT was then able to visit Miss G in order to carry out an assessment of the home.
33. In January 2022, the Council wrote to Miss G to confirm the outcome of her financial assessment. The letter notified Miss G that she would not need to contribute towards the cost of her care and support package.
34. In February 2022, the OT made a number of property alteration recommendations in order to support Miss G’s needs at home. This included enlarging Miss G’s ensuite bathroom to make it more accessible to include a level access shower.
35. In March 2022, the Council sent Miss G a formal DFG application pack relating to the recommended home adaptations. The Council told Miss G this application would need to be completed in order for the recommended works to commence. However, the Council sent Miss G the incorrect application pack and did not rectify the issue until July 2022 therefore resulting in delay.
36. In April 2022, the Council’s Direct Payments team said it closed Miss G’s referral for a Direct Payment due to a lack of response over a three-month period. The Council said Miss G has not completed the Direct Payment forms which were sent to her electronically and by post. As I understand, Miss G has since accepted a package of care commissioned by the Council.
37. The Council has since confirmed that Miss G has now returned her completed application pack. The case is currently with the Council’s relevant team which is working to complete the contractor tendering process.

My assessment

Time limits

38. I cannot by law investigate a complaint made more than 12 months of the complainant becoming aware of the problem, unless there are good reasons to exercise discretion. On the face of it, there are parts of Miss G’s complaint which are late. However, an alleged failure of care and support is a continuing issue. I am therefore exercising my discretion to investigate all parts of the complaint.

Care assessment

39. The Care and Support Statutory Guidance says that an assessment should be carried out over an appropriate and reasonable timescale, taking into account the urgency of needs and considering any fluctuation in them. We expect councils should complete assessments in a timescale that is proportionate to the complexity of the issues, and normally within 28 calendar days. One purpose of my investigation is to determine whether the Council delayed in completing the assessment process which in turn delayed Miss G accessing care and support.
40. The Council carried out a care assessment of Miss G’s needs in October 2019. Miss G complains the Council has unreasonably delayed in carrying out the assessment process. The evidence shows the Council sent Miss G forms in November 2019 in order for it to undertake a financial assessment to determine any level of contributions she needed to make towards her identified needs. I found that Miss G did not want to complete the forms immediately as she was unsure if she wanted the package of care. She also wanted to find out whether her claim for PIP would be successful before continuing with the assessment.
41. The evidence shows that Miss G contacted the Council in late December 2019 to say she had filled in the financial assessment forms. Miss G asked for the forms to be collected in person by the Council. The Council told Miss G the form could be posted or sent electronically by email. Following this, the Council received Miss G’s forms in February 2020. However, the Council says Miss G did not provide all the necessary information in order for the Council to complete the assessment. It says this meant it had to contact the DWP to ascertain details about Miss G’s benefits income.
42. It would not be correct to say the Council has delayed in carrying out the assessment process since Miss G’s needs were assessed in October 2019. The Council cannot undertake an assessment absent the necessary forms and accurate details of Miss G’s finances. That said, the Council has acknowledged there was a delay in carrying out the financial assessment once Miss G returned the forms. It said the forms had been sent to the wrong team at the Council which meant they were not acted on as quickly as they should have been. I have therefore identified some fault by the Council.
43. The Council completed the financial assessment process in late April 2020. Initially, I was told by the Council that it had sent Miss G a letter confirming that she would not need to contribute towards her care and support needs. However, the letter does not confirm this and is limited to explaining to Miss G that there has been a delay in carrying out the assessment process. Rather, the Council did not send Miss G a letter confirming the outcome of the financial assessment until January 2022. The Council said this should have been done in April 2020, but due to human error the letter was not issued to Miss G as it should have been.
44. As said, I do not consider the delay in carrying out the assessment rests entirely on the Council. There have clearly been some issues outside of the Council’s control. However, my view is that Miss G should have been notified of the financial assessment outcome by April 2020 so she could have made an informed decision as to whether she wanted to receive her assessed care and support package. For the reasons given, this did not happen due to human error and so I do find fault by the Council. This constitutes a delay of 20 months. I consider this failing would have caused serious distress and uncertainty to Miss G who was relying on the financial assessment outcome to understand whether she could afford her package of care and support. I will assess whether this failing caused Miss G to suffer a loss of care and support separately (below).

Home adaptations

45. Separate to Miss G’s care and support needs, the Council has also explored assisting her with home adaptations to make her property more suitable for her needs. Before doing so, an OT visits the service user to carry out an assessment and make recommendations as to any adaptations. The Council initially sought to make an assessment in this respect in June 2020. Miss G says the Council has failed to undertake the adaptations which has caused her significant hardship.
46. In my view, there has been some challenges outside of the Council’s control in arranging to visit Miss G and carry out an OT assessment. When the Council contacted Miss G to organise an OT visit in mid-June 2020, Miss G said she wanted this process to be placed on hold. This is because she did not feel comfortable having home visitors during the Covid-19 pandemic. However, Miss G later contacted the Council and consented to a visit the next month.
47. I have reviewed the correspondence between Miss G and the Council. In my view, this shows the Council has had difficulty arranging a time to visit Miss G and carry out the OT assessment. An OT attempted to visited Miss G in late July 2020, though there was no answer. A further visit was organised for mid-September 2020. However, Miss G cancelled the visit due to not being well. The OT subsequently offered Miss G two dates in October 2020, though was rearranged to November 2020 due to the OT no longer be available. Due to having a fall, Miss G asked for an alternative date in early December 2020. I consider the Council has offered a range of dates and sought to accommodate Miss G in arranging a suitable visit. I have not identified any fault by the Council with respect to its attempts to progress Miss G’s request for home adaptations.
48. The OT assessment was undertaken by the Council in February 2022 following a date being agreed with Miss G. The OT made a number of property alteration recommendations in order to support Miss G’s needs at home. This included enlarging Miss G’s ensuite bathroom to make it more accessible to include a level access shower. The Council has offered to undertake the works and recommended it be funded using a DFG. The Council sent Miss G a formal DFG application pack which contained guidance and advice for her consider, sign and return. However, Miss G noticed that DFG included the following condition:

“If the works amount to more than £5,000 a charge will be placed on the property. This means if you sell your house within 10 years of completing the work, you have to repay the full amount, or £10,000, whichever is the lesser amount.”

49. The application pack (2013) sent by the Council was out of date which it has acknowledged as was fault on its part. The latest application pack (2019) should have been sent instead which includes an amended condition, as follows:

“If the works amount to more than £12,000 a charge will be placed on your property. This means if you sell your house within 5 years of completing the work you have to repay the full amount or £10,000 whichever is the lesser amount.”

50. On receipt of the outdated application pack, Miss G noticed it included the wrong condition wording and so she was justifiably not in a position to sign the necessary documentation for her home alterations to proceed. Between receiving the application pack arriving in March 2022 and June 2022, Miss G raised this problem with the Council on a number of occasions by email. I have read the email correspondence between Miss G and the Council on this issue which demonstrates a failure by the Council to take appropriate action.
51. In my view, the Council dismissed Miss G’s legitimate concerns and provided responses which were generally unhelpful and did not address the error in the application form. Only following a review in July 2022 did the Council realise the error it had made and then sent Miss G the correct application pack with the appropriate wording. This was further fault by the Council which in turned delayed Miss G’s application and caused her unnecessary distress and uncertainty. I consider the injustice to Miss G was aggravated further given she is disabled and vulnerable and because completing the application pack was necessary for the approval of her home alternations under a DFG.

Package of care

52. In addition, Miss G complains the Council has failed to provide her with her package of care which it assessed her for in October 2019. She therefore says the Council is failing to meet her assessed eligible care and support needs. Following the outcome of the financial assessment in April 2020, the evidence shows the Council could have commissioned Miss G’s package of care. As found, the Council failed to notify Miss G of the financial assessment outcome until January 2022 which meant she could not make an informed decision as to whether she wanted to receive care and support from the Council.
53. However, in June 2020, the Council says it spoke with Miss G and noted that she no longer wanted to receive the package of care. The evidence I have reviewed shows that Miss G declined help with personal washing and bathing. Separately, the Council’s records also refer to Miss G wanting to pay for her own private cleaner. Because this amounted to the entire assessed care package, the Council felt Miss G no longer wanted this. That said, the Council became aware from Miss G’s sister-in-law in July 2020 that Miss G did want help with cooking and the domestic cleaning parts of the package of care. It is denied by Miss G that she told the Council she did not wish to receive this assistance and she did make the Council aware of this misunderstanding, also in July 2020.
54. Because Miss G said she did not want part of the assessed care package, I do consider a further care assessment was necessary. Further, it is good practice and expected that local authorities carry out a care plan review annually in order to ensure they meet a service user’s needs. The Council sought to arrange a number of visits with Miss G, though these were unsuccessful. Importantly, the Council did offer to implement a care package for Miss G on the information it had. However, Miss G did not confirm how she wanted to the care package to be delivered and so it could not be implemented by the Council. This being said, Miss G had not still not received the financial assessment outcome and so I do not consider she was able to make an informed decision whether she could afford the domestic help which was assessed as an eligible support need.
55. In August 2021, the Council carried out a further care assessment to ascertain Miss G’s needs. That said, I do consider the Council was under duty to provide the assessed domestic help since April 2020 because this is when Miss G should have been notified of the financial assessment outcome to allow her to make and informed decision whether to accept the support she said she wanted. Following the latest care assessment, the Council subsequently offered a package of care and support and Miss G requested receiving a Direct Payment. The case notes record that Miss G was offered a Council commissioned service as an interim measure, though she stated her preference was to wait. However, the Council said it never received the necessary documentation from Miss G to implement a Direct Payment. The Council therefore closed the Direct Payment request in April 2022 after a number of months of not receiving a response from Miss G.
56. The evidence presented shows Miss G was sent a written outcome of the financial assessment in the post in January 2022. I consider, from this point, that she was in a position to choose whether to accept the assessed care package. As I understand, Miss G has since agreed to a Council commissioned service which has been implemented. However, as acknowledged by the Council, Miss G should have been provided the outcome of the financial assessment in late April 2020. In my view, Miss G was justified in not choosing to accept the care package without confirmation as to costs. As a result of this serious 20-month delay, the Council was not providing Miss G with her eligible care and support needs. I therefore find fault by the Council for not providing Miss G with the domestic help she was entitled to receive. This caused her a serious and personal injustice as her needed support was not provided which resulted in significant hardship.

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Agreed action

57. To remedy the fault and injustice identified, the Council has agreed to perform the following actions by 1 November 2022:
1. Provide Miss G a written apology for the delay in undertaking her financial assessment relating to her care needs.
2. Pay Miss G £250 to acknowledge the stress and uncertainty reasonably caused to her because of the delay in processing her financial assessment.
3. Pay Miss G £350 to acknowledge the stress and uncertainty reasonably caused to her because of the delay in relation to her DFG application. This, in turn, has delayed her needed home alterations.
4. Pay Miss G £880 (£40 per month) due to a 22-month delay in providing her with her assessed eligible needs (namely domestic help and support).
5. Investigate the reasons why Miss G was not notified of the financial assessment outcome in April 2020 and the reasons it took until January 2022 for this to happen. This should inform feedback and guidance to staff dealing with financial assessments, as well as measures to avoid similar occurrences.

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Final decision

58. I found the Council was responsible, in part, for delaying Miss G’s needed home alterations by sending her incorrect information relating to a DFG. Moreover, the Council was responsible for a serious delay in completing Miss G’s financial assessment which would be used to inform any contributions Miss G would need to make towards her care. This in turn delayed Miss G being provided with her needed care and support. The failings have caused Miss G an injustice the Council has agreed to my recommendations to remedy this.

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Investigator's decision on behalf of the Ombudsman