Summary: Mr X complained about how the Council dealt with the care and support needs assessment for his mother, Mrs Y. He also complained about how the Council dealt with the individual carer assessments for two family carers, Carers 1 and 2. There was fault by the Council with how it assessed Mrs Y’s care and support needs. It was at fault with how it dealt with the carers assessments for Carers 1 and 2. The Council was also at fault with its complaints handling process. This caused injustice to Mrs Y and her family. The Council will take action to remedy the injustice caused.

The complaint

1. Mr X is Mrs Y’s son, and he has power of attorney.
2. Mr X complained on behalf of his mother (Mrs Y) and two family carers (Carer 1 and Carer 2). Mr X is their representative.
3. Mr X complained about the Council’s:

• failure to properly conduct the Care and Support Needs Assessment for Mrs Y dated 28 January 2022
• refusal, delays and failure to complete individual Carer Assessment and meet the needs of Carer 1 and Carer 2 since April 2021 to date.

4. Mr X said as a result of the Council’s failings, Carer 1 and Carer 2 were left with no support in their caring roles and especially Carer 2 who suffers from mental ill health. Mr X also said the matter caused the family members distress and the time and trouble chasing the Council and complaining.

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The Ombudsman’s role and powers

5. 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 significant injustice, or that could cause injustice to others in future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
6. 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 has done. (Local Government Act 1974, sections 26B and 34D, as amended)
7. Under our information sharing agreement, we will share this decision with the Care Quality Commission.
8. 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)

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How I considered this complaint

9. I have discussed the complaint with Mr X and considered the information he provided. I also considered the information the Council provided in response to my enquiries.
10. I have exercised discretion to investigate matters from 2021. This is because I needed to consider the whole period to carry out a meaningful investigation.
11. I sent Mr X and the Council a copy of my draft decision and considered all comments received before issuing a final decision.

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What I found

Legislation and Guidance

12. 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. They must provide an assessment to everyone regardless of their finances or whether the council thinks the person has eligible needs. 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. Councils must carry out assessments over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Councils should tell people when their assessment will take place and keep them informed throughout the assessment.
14. Assessments can be carried out in various ways such as face to face, supported self-assessment, online or phone, joint assessment, and combined assessment (with other individuals such as parents, carers).
15. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan which must be ‘person-centred’. The plan should consider what needs the person has, what they want to achieve, what they can do by themselves or with existing support and what care and support may be available in the local area. When preparing a care and support plan, the council must involve the person and any relevant people, such as the carer(s) the adult has.

Carer’s Assessment

16. Where somebody provides or intends to provide care for another adult and it appears the carer may have any needs for support, the council must carry out a carer’s assessment. A carer’s assessment 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.
17. As part of the carer’s assessment, the council must consider the carer’s potential future needs for support. It must also consider whether the carer is, and will continue to be, able and willing to care for the adult needing care. (Care and Support Statutory Guidance 2014)

What happened

18. This chronology sets out key events in this case and does not cover everything that happened.
19. Mrs Y has dementia and some other health conditions.
20. After Mrs Y’s husband passed away, the family felt it was unsafe for her to live alone. Two family carers, Carer 1 and Carer 2 (a couple) moved in with Mrs Y to care for her.
21. Mrs Y is a self-funder and meets the full cost of her care. Mr X privately arranged three hours formal care support every week for Mrs Y (showering support) and regular respite for her at a residential care home. This was to provide Carers 1 and 2 with some break from their caring roles.
22. Mr X said it quickly became apparent Mrs Y needed increased care and support due to a decline in her health. Mrs Y’s family contacted and asked the Council to assess Mrs Y’s care and support needs.
23. In May 2021, the Council completed a care and support needs assessment for Mrs Y and found her eligible for care and support. The Council made an occupational therapy (OT) referral for suitable equipment to help Mrs Y mobilise safely within her home. During Mrs Y’s assessment, Carers 1 and 2 were identified as family carers for Mrs Y. In particular, the Council identified Carer 2 (the main carer) had mental health conditions and was finding it difficult to cope in her caring role. Carer 1 worked full time, he provided care and support to Mrs Y and Carer 2 when required. Mrs Y’s family asked the Council to complete an independent carer assessment each for Carer 1 and Carer 2.
24. The Council closed Mrs Y’s case following her May 2021 care and support needs assessment.
25. Mrs Y’s family chased the Council several times for the carers assessments and especially for Carer 2 due to her mental health condition. In July 2021, the Council sent two carers assessment forms to Carers 1 and 2 to complete and return to it. Mr X said Carers 1 and 2 were both overwhelmed with their caring roles and were unable to complete the forms. The family informed the Council that self‑assessments were not suitable for both carers and asked it to conduct a face-to-face independent carers assessment for each of the carers.
26. In September 2021, Mrs Y’s family contacted the Council again for an update on the two carers assessments. There were some internal emails sent between the Council’s departments to refer and arrange the carers assessments for Carers 1 and 2.
27. In December 2021, the Council contacted Mrs Y’s family. The Council said it would carry out another care and support needs assessment for Mrs Y and complete carers assessments for Carers 1 and 2. Mrs Y’s family questioned why the Council wanted to re-assess Mrs Y’s needs especially when it had just assessed her in May 2021. Mrs Y’s family reiterated their request for an independent carer assessment for each of the carers and not a combined assessment with Mrs Y. This was so the Council could identify each carer’s needs, explore and agree an appropriate support plan for each of them. The Council asked Carers 1 and 2 to each complete an online carer assessment form prior to the assessment date.
28. On 28 January 2022, the Council completed a combined assessment for Mrs Y and both carers. It completed a care and support needs assessment for Mrs Y and carer assessments for Carer 1 and Carer 2.
29. The Council found Mrs Y was not eligible for care needs. The Council said it did not receive Carer 1’s completed online carer’s form and that Carer 2’s form was partially and incorrectly completed. It found both carers were not eligible for carers support. The Council said Carer 2’s mental health condition was not as a direct result of her caring role because this existed prior to when she started caring for Mrs Y. But it signposted Carer 2 to the Community Mental Health Team for support with her mental health condition. The Council also advised the family could increase Mrs Y’s existing respite and formal care package. It said this would reduce the time Carer 2 spent in her caring role and would support her wellbeing.
30. Between February and April 2022, Mrs Y’s family chased the Council for the copies of the assessments it completed for Mrs Y, Carer 1 and Carer 2 in January 2022. In mid-April 2022, the Council issued copies of the assessments to Mrs Y’s family. The Council apologised for the delay and said it was due to the new computer systems within the service.
31. In December 2022, Mr X made a formal complaint to the Council. He complained the Council failed to properly conduct Mrs Y’s care and support needs assessment on 28 January 2022. Mr X also complained about how the Council dealt with the carers assessments for Carers 1 and 2. This included the Council’s several months of delay in conducting the carers assessments, its use of unsuitable self-assessment forms for the carers and the inaccuracies in all the three assessments completed. Mr X asked the Council to remove the inaccurate information about his family from the assessments. Mr X said the Council’s failings caused Mrs Y and the family distress, disappointment, time and trouble and had particularly worsened Carer 2’s mental health and wellbeing.
32. In March 2023, the Council responded to Mr X’s complaint. It acknowledged its delays in conducting independent carers assessments for Carers 1 and 2 and its failure to explore how to support each of them in their caring roles. The Council acknowledged there was a difference between the outcomes of the care and support needs assessments it completed for Mrs Y in 2021 and 2022. It said Mrs Y’s 2022 assessment failed to accurately identify her needs and it failed to fully report her family’s circumstances. The Council apologised for its failings and the distress caused to the family. It said it would arrange formal training for its staff and it offered Mrs Y’s family the opportunity to conduct all the three assessments again. The Council said it was waiting to get further guidance about Mr X’s request for it to remove the inaccurate information from the family’s records. It said it would update Mr X on the outcome once received.
33. The Council contacted Mrs Y’s family to discuss its response letter. The family said they needed to discuss the Council’s offer to conduct all the three assessments again and that they would update the Council about their decision. The Council issued Mrs Y’s family with its direct contact details.
34. Mr X remained dissatisfied with the Council’s response to his complaint. He made a complaint to the Ombudsman. Mr X said the family had verbally accepted the Council’s offer to re-do all the three assessments during the telephone call with the Council in March 2023. He confirmed the Council was yet to complete all the reassessments.
35. In response to our enquiries, the Council apologised again for the negative experience, stress and time and trouble its failings as identified in its March 2023 letter to Mr X had caused Mrs Y’s family. The Council said it had offered to re‑assess Mrs Y, Carer 1 and Carer 2 but said Mrs Y’s family is yet to accept the offer. It confirmed its offer to conduct all three assessments was still available to the family. The Council said it had received guidance about Mr X’s request for it to delete the inaccurate information contained in the assessment records. The Council confirmed it cannot delete or amend assessments records. But it can offer Mrs Y’s family an opportunity to have their views recorded alongside the existing records in line with its guidance.

Analysis

36. There were faults by the Council in how it dealt with Mrs Y’s care and support needs assessments and how it dealt with the carers assessments for Carers 1 and 2.

Mrs Y’s Care and Support Needs Assessments

37. It is not the Ombudsman’s role to decide whether a person has care needs. Our role is to establish if the Council assessed a person’s needs properly and acted in accordance with the law.
38. I have no criticism about the care and support needs assessment itself, which the Council completed for Mrs Y in May 2021. The Council properly considered and identified her care needs, found her eligible and made an OT referral to support her identified needs. This was not fault. However, there was no evidence to show the Council drew up a care and support plan for Mrs Y following the May 2021 assessment. Under the Care Act 2014, councils should produce a care and support plan when it finds someone has eligible needs. The support plan should set out all existing and agreed support and show how the support will be met. Therefore, I find fault by the Council for not producing a support plan for Mrs Y even if it only made a referral to the OT. This meant Mrs Y was left without a care and support plan, so she may not have understood how her needs would have been met.
39. I find fault by the Council with how it completed Mrs Y’s care and support needs assessment in January 2022. I note the outcome of the assessment was that Mrs Y was not eligible for care needs which was different from the initial outcome in 2021. While I accept professional opinion may differ, there was no evidence to show the Council properly considered and identified Mrs Y’s needs. It failed to properly consider how her care needs impacted on her daily living before it reached its decision that Mrs Y did not have eligible care needs. This was fault. And the Council acknowledged it failed to accurately assess Mrs Y’s care and support needs during this assessment.
40. Also, the Council conducted Mrs Y’s 2022 assessment as a combined assessment with Carers 1 and 2 despite the family’s request to have separate assessments for three of them. The Council should have agreed to separate all the assessments as requested, unless it gave the family a good reason why it could not. There was no evidence of such reason(s) given by the Council. This was fault. I also found the combined assessment form was difficult for the reader to understand and it lacked sufficient detail about Mrs Y’s needs in line with statutory guidance. This was fault.
41. The faults with Mrs Y’s 2022 care and support needs assessment caused distress and uncertainty to Mrs Y’s family. The family was uncertain whether the Council properly assessed Mrs Y’s care needs and not knowing if she would have benefitted from additional support to meet any identified needs.

Carer’s Assessment for Carer 1 and Carer 2

42. I find fault by the Council in how it dealt with the carers assessments for Carers 1 and 2. The faults identified are as follows:

• During Mrs Y’s care and needs assessment in May 2021, the Council identified Carers 1 and 2 as her family carers. Evidence shows the Council subsequently closed Mrs Y’s case and failed to conduct carers assessments for both carers in line with the Care Act. This was fault. The Council missed the opportunity to find out each of the carer’s needs for support, the sustainability and the impact of their caring roles on their wellbeing. More so with Carer 2 (main carer) who informed the Council during that assessment that her caring role was affecting her existing mental health condition.
• The Council’s delay with conducting carers assessment for Carers 1 and 2. Mrs Y’s family chased the Council for both carers assessments between May 2021 to December 2021. The Council eventually conducted the carers assessments for Carers 1 and 2 in January 2022. This was a significant delay, and it was fault. This caused Carers 1 and 2 significant distress and uncertainty in not knowing if they would have been eligible for any support in their caring roles, especially Carer 2 who suffers from mental ill health. This also caused Mrs Y’s family members distress and the time and trouble chasing the Council and complaining.
• I note Mrs Y’s family asked the Council on several occasions to complete a face-to-face independent carers assessment for Carers 1 and 2 separately. The family told the Council this was because both carers struggled with self‑assessments due to the impact their caring roles had on them. Evidence shows in July 2021 and December 2021, the Council sent self‑assessment forms to both carers to complete. This was fault. This is because the Council failed to adapt and use the appropriate method in assessing Carers 1 and 2. This caused distress, worry and frustration to Carers 1 and 2. It also meant both carers were disadvantaged by the Council’s failure to properly assess their individual needs in their respective caring roles as a result of using unsuitable assessment methods.
• As already explained above, the combined assessment the Council conducted in January 2022 for Mrs Y and both carers was flawed. The assessment form was difficult for the reader to understand, and it lacked sufficient detail about Carers 1 and 2’s needs. While I acknowledge the Council did not receive Carer 1’s self-assessment form and it received an incomplete form for Carer 2, this again goes to the point the Council failed to use the appropriate assessment method for them. This was fault. It caused uncertainty to both carers not knowing whether the Council properly assessed their needs and if they would have benefitted from any support to meet any identified needs.
• I also find the back-and-forth internal emails sent between the Council’s different departments in September 2021 contributed to the delay in completing the carers assessments in a timely manner. This was fault. Similarly, there was a delay by the Council in sending the three assessment documents to Mrs Y’s family due to its new computer systems. The Council sent the forms to the family in mid-April 2022 following the January 2022 combined assessment. This was fault and caused the family further distress and worry about the outcome of the assessments.

43. Furthermore, I find fault by the Council in its complaint handling process. There was a delay with the Council issuing its response to Mr X’s complaint within 20 working days in line with its complaints process. Mr X made his complaint in December 2022 and the Council issued its response to his complaint in March 2023. This caused distress to Mr X.
44. Having said that, I note the Council acknowledged some of these failings and it had apologised to Mrs Y’s family and offered to re-assess Mrs Y, Carer 1 and Carer 2. But I do not consider these remedies are proportionate and sufficient to acknowledge the injustice (as mentioned above) caused to Mrs Y, Carer 1, Carer 2 and Mr X as a result of the Council’s failings. This has been addressed in the ‘agreed action’ section below in accordance with our guidance on remedies.

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Agreed action

45. To remedy the injustice caused by the faults identified, the Council has agreed to complete the following within one month of the final decision:

• apologise in writing to Mrs Y, Carer 1 and Carer 2 for the injustice caused to them as identified above by the Council’s failure to properly complete their respective assessments in January 2022. The apology should be in accordance with our new guidance, Making an effective apology
• contact Mrs Y’s family and arrange a date to re-assess Mrs Y’s care and support needs and to complete a face-to-face independent carers assessment each for Carer 1 and Carer 2
• offer Mrs Y’s family an opportunity to have their views recorded alongside the alleged existing inaccurate information within Mrs Y, Carer 1 and Carer 2’s assessment records
• pay a symbolic payment of £250 each to Carer 1 and Carer 2 for the distress caused to them by the Council’s failings as identified above
• apologise and pay a symbolic payment of £100 to Mr X in recognition of the distress caused by chasing the Council about the carers assessments over a considerable period
• if the Council finds Mrs Y, Carer 1 and Carer 2 have eligible needs after it completes all the re-assessments, then the Council should consider a suitable remedy to acknowledge any support they might have missed out on to meet their respective identified needs. For Mrs Y, the period should be from January 2022 and for Carers 1 and 2, this should be from May 2021
• by training or other means remind staff of the importance of completing care and support assessments and carers assessments in a timely manner, using the appropriate assessment method(s) and in line with the Care Act. This is to ensure care and support needs are identified and met
• remind front-line staff about the importance of keeping service users’ cases moving and dealing with the cases in a timely manner
• remind relevant staff of the need to provide responses to complaints within the appropriate timescales in line with the Council’s complaint handling procedure.

46. Explain to the Ombudsman how the Council will monitor its performance against timescales.
47. The Council should provide us with evidence it has complied with the above actions.

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Final decision

48. I find evidence of fault by the Council leading to injustice. The Council has agreed to take action to remedy the injustice caused.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman