Summary: Ms C complains the Council failed to properly assess her needs and provide suitable support. The Council is at fault for failing to properly record a care needs assessment and how it made service decisions. This has caused Ms C anxiety, distress, frustration, and uncertainty. To put things right the Council has agreed to apologise to Ms C, offer a reassessment, make a symbolic payment, and make service improvements.

The complaint

1. Ms C complains the Council failed to:-
1. properly assess her care needs,
2. include her religious and cultural needs as part of her assessment,
3. offer a direct payment to meet her needs,
4. inappropriately repeatedly offered reablement services,
5. consider her complaints properly.
2. Ms C also complains about occupational therapy services which for the reasons set out below I have not investigated.
3. Ms C says because of these failures she has not had the services she needs and has had to pay for private care to manage her daily living. Ms C says the Council’s failures have caused her avoidable time, trouble, and frustration and this has affected her health.

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The Ombudsman’s role and powers

4. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word fault to refer to these. We consider whether there was fault in the way an organisation made its decision. If there was no fault in how the organisation made its decision, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
5. 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)
6. 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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What I have and have not investigated

7. Ms C has complained about Occupational Therapy (OT) and social care services from 2021. I have exercised the Ombudsman’s discretion to consider matters from April 2022 about Ms C’s social care complaints but not occupational therapy services. This is because Ms C complained about OT issues in 2021 but did not escalate the matter. While there was delay in Ms C bringing social care matters to our attention the Council partly caused the delay.

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How I considered this complaint

8. I spoke with Ms C and considered information she sent. I made enquiries of the Council and considered its response. I considered:-
• Care Act 2014 and the associated Care and Support Statutory Guidance;
• Ms C’s care records including care assessments;
• complaint correspondence;
• Council’s Reablement and Complaint policy.
9. Ms 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

Background information

10. Ms C has long COVID which has affected both her physical and mental health. Ms C received reablement services from a neighbouring authority. She moved into Redbridge and approached the Council for occupational therapy support. Ms C wanted support for her care needs and the Council records on 14 April 2022 she asked for a care assessment.

What should have happened

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. 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.
12. 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.
13. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan (or a support plan for a carer). The care and support 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 any carer the adult has. The support plan must include a personal budget, which is the money the council has worked out it will cost to arrange the necessary care and support for that person.
14. Direct payments are monetary payments made to individuals who ask for them to meet some or all their eligible care and support needs. They enable people to arrange their own care and support to meet those needs.
15. Reablement services help people live independently and provided in the person’s own home by a team of mainly care and support professionals.
16. Council’s “Reablement Standard Operating Procedure” scope of service says, “The service will be outcome focused ensuring that reablement sessions are directed towards achieving goals agreed with the service user at the initial assessment stage.
17. Service users have a right to express their views and wishes about the detailed implementation of their reablement care plan and every effort must be made to provide services in accordance with these views whilst recognising that there are practical parameters to service delivery and short notice changes. The service user’s wishes regarding their own home conditions and their personal care should be respected and the way in which the service user is supported must be appropriate to, and respectful of, their religious and cultural backgrounds and their gender and sexuality.”
18. Councils should have clear procedures to deal with social care complaints. Regulations and guidance say they should investigate and resolve complaints quickly and efficiently.

What happened

19. The Council records on 6 May Ms C asked for information about the care needs assessment process. A social worker from the “First Contact” team provided this information and following agreement from Ms C made a referral for an advocate. Because of a delay in getting an advocate and Ms C’s urgent needs the social worker started a telephone assessment on 10 May. The social worker set up a preventive/crisis care package of seven hours per week to support Ms C. The social worker referred Ms C to the long term team assessment team.
20. Following contact from Ms C on 1 June the Council told her she was on a waiting list. The Council assigned a social worker on 26 July but for various reasons did not complete a virtual assessment until 4 October. The assessment stated the Council would increase Ms C’s care package to 14 hours per week. It included information about a direct payment and how Ms C could use a direct payment.
21. Ms C was unhappy with the assessment and raised her concerns with the Council. Following a discussion with their manager the social worker told Ms C the Council could meet her needs through reablement services. On 7 November Ms C met virtually with the Council and expressed her concerns about this decision. Ms C later made a written complaint to the Council about its failure to act in a person centred way and its refusal to offer Ms C a direct payment.
22. The Council responded on 15 December saying,
23. “Ms C (sic) is able to have care and support provided via a direct payment mechanism, (sic) This is n (sic) no means being disputed, however information provided at the point of assessment did identify that a viable option of support for Ms C in order to promote her wellbeing and independence was for a Reablement provision to be explored and provided initially. Of course after this period any identified long term needs can of course be offered via a Direct Payment method”
24. The Council offered to meet with Ms C,
25. “to discuss the content of the assessment and also the offered services of Reablement”, and to “explore the option set out and …for a new assessment to be offered jointly with both the Occupational Therapist and Social Worker in order to ensure there is an ability for all information Ms C (sic) feels has not been captured to be addressed”.
26. The Council had a further virtual meeting on 22 December to discuss Ms C’s concerns. The officer involved could not comment on Ms C’s main concern about a direct payment. The officer asked Ms C if she wanted another assessment. The officer also questioned Ms C about her refusal to allow the Council to contact her GP for information about her medical condition and how it affected her independence. Ms C stated she had not refused permission and the Council had all the relevant medical information.
27. The Council then put in a care package as part of reablement which Ms C cancelled. The notes record Ms C asked the social worker to contact her on 21 December but did not receive a response, and soon after formally complained to the Council. The Council did not respond until Ms C complained to the Ombudsman in February 2024. The Council accepted its oversight and in recognition of the lack of response agreed to pay Ms C £100 for her time and trouble. It also agreed to work with Ms C to look at her care needs. The Council says the offer of reablement remains open to Ms C.

Was there fault causing injustice?

Delay in the assessments

28. There was a delay between 10 May and 26 July before the Council assigned a social worker to complete an assessment. The Council started the assessment on 4 October and completed it over several calls to enable Ms C to take part as fully as possible. The Council finished its assessment in November 2022.
29. I consider the early delay between 10 May and 26 July of nearly two and a half months was fault. I do not consider there was delay from the Council once it assigned a social worker because the delays were caused by events outside the Council’s control. They included the lack of availability of an advocate and Ms C’s ill health.
30. Because of the Council’s initial delay Ms C had frustration, time, and trouble in chasing the Council.

Assessment and support planning

31. The Ombudsman cannot criticise a professional judgement unless there is procedural fault. My role is to consider whether the Council has followed the correct procedures in assessing Ms C. The Council:-
• provided Ms C an advocate to support her through the assessment process;
• agreed to meet with Ms C several times to consider her views and needs;
• reviewed the assessment following further information from Ms C which includes Ms C’s religious and cultural needs.
32. This is evidence of good practice. However I consider the Council has not properly assessed Ms C’s needs. The Council’s additions recorded as “conversations” to an earlier assessment completed by a different authority does not properly identify Ms C’s needs. The Council also delayed in providing Ms C with information contained in the assessment, so it was difficult for her to initially challenge decisions. This is fault and not in line with the Care Act and the associated guidance.
33. The Council can decide where suitable that reablement services are appropriate. However the assessment for Ms C does not provide a rationale for this conclusion. Also the first assessment identified that a direct payment would meet Ms C’s needs. While I cannot say now that this would be the outcome had the Council completed a full assessment; Ms C has the uncertainty the Council has not offered her services to meet her needs. Ms C also had a legitimate expectation that she would receive a direct payment.
34. The Care Act says people should be involved in their care planning. Ms C has provided several reasons why the reablement service would not meet her needs. I do not consider the Council has properly considered these views. Ms C had a reablement service from a previous authority. I consider the Council should have reviewed this service, the objectives it set out to meet and why it was ineffective. Ms C also received a short term preventive package from the Council which highlighted the problems Ms C was having with receiving support from a care agency. There is a lack of analysis about why this was not working and how a reablement service would help.
35. As part of the assessment process it is legitimate for the Council to ask for medical information if it feels this is necessary. In this case to see whether it can find out if Ms C’s health will improve in the immediate future and how her health affects her. While Ms C provided medical information in the past, it is up to the Council to decide whether it needs other, or more recent information to make an eligibility decision. I therefore find no fault in the Council asking for current medical information.

Complaint handling

36. The Council has accepted it did not respond to Ms C’s complaint in a timely manner and that Ms C had time and trouble pursing the Council to get an update and a response. While the Ombudsman welcomes the actions of the Council I also consider it needs to make service improvements.

Injustice

37. Ms C has been caused time, trouble, anxiety and frustration by the delays and faults I have identified. However the Council has asked Ms C several times whether she would like a reassessment. While I understand Ms C’s reluctance to accept a reassessment the Council must protect the public purse and ensure that it provides services to those that meet its eligibility criteria. While I understand Ms C finds the assessment process emotionally and physically draining she has had opportunities to mitigate her injustice.

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Agreed action

38. I consider there was fault by the Council which has caused Ms C injustice. I consider the agreed actions below are suitable to remedy Ms C’s personal injustice and to improve future practice.
39. Within one month of the final decision the Council will:-
1. apologise to Ms C for the delay and flaws in the complaints, assessment, and support planning;
2. pay Ms C £350 a symbolic payment to reflect the anxiety, distress and frustration caused by the faults I have identified above;
3. offer Ms C a reassessment. If Ms C agrees to this, a social worker and associated manager not previously involved should complete the assessment. If Ms C agrees the Council should also get an advocate to support Ms C;
40. Within three months of the final decision the Council will:-
1. review the complaint handling in this complaint and if applicable produce an action plan to avoid future reoccurrence;
2. review the initial delay in assigning a social worker and if applicable produce an action plan to avoid future reoccurrence;
3. remind staff by a staff circular or through team meetings about completing assessments and support plans so they are clear and provide a justification for service decisions;
4. remind staff by a staff circular or through team meetings about sending copies of assessments to participants.
41. The Council should provide us with evidence it has complied with the above actions.

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Final decision

42. I have found fault in the actions of the Council. I consider the above actions are suitable to remedy Ms C’s personal injustice and make service improvements. I have ended my investigation and closed the complaint on this basis.

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Investigator's decision on behalf of the Ombudsman