Summary: Ms X complained about the way the Council conducted a Care Act assessment of her needs, and how it responded to her complaints about that matter. The Council was at fault as it delayed completing an assessment and providing appropriate support for Ms X and did not keep clear and accurate records. The Council will apologise to Ms X and pay her £3,000 to recognise the injustice caused to her by the faults and improve its services to avoid similar drift and delay in the future.

The complaint

1. Ms X complained about the way the Council conducted a Care Act assessment of her needs, and how it responded to her complaints about that matter. Specifically Ms X complained:
1. The Council delayed in completing an assessment of her needs and failed to adequately explain the lengthy delay in carrying out the assessment;
2. The Council’s social worker stated they would complete referrals to other services for financial support for Ms X but did not complete the referrals and the Council did not respond to her complaint on that matter;
3. The Council’s social worker told Ms X they had completed the assessment in February when the assessment had not in fact been completed; and
4. The Council failed to communicate between the adult social care teams and mental health services so Ms X’s phone messages were not responded to and officers she spoke to could not provide an update.
2. Ms X said the delay in the assessment and the Council’s poor complaint handling has been detrimental to her mental health, and the lack of referrals for financial support made her financial situation worse, which also affected her mental health. Ms X wanted the Council to acknowledge the impact of its actions, provide an explanation of the delay and apologise, and to improve its service.

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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 significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. We investigate complaints about councils and certain other bodies. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, section 25(7), as amended)
5. When considering complaints we make findings based on the balance of probabilities. This means that we look at the available relevant evidence and decide what was more likely to have happened.
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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How I considered this complaint

7. I read the documents Ms X provided and discussed the complaint with her on the phone.
8. I considered the documents the Council sent in response to my enquiries.
9. Ms X 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

Assessment

10. 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.
11. 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.
12. The Care and Support Statutory Guidance explains that a supported self-assessment is where the person completes the assessment themselves and the council assures itself that it is an accurate reflection of the person’s needs. For example, it might consult with other relevant professionals and people who know the person with their consent. Whilst the person fills in their own assessment form, the duty to assess their needs, and ensure the assessment is accurate and complete, remains with the council.

Care Plan

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. 

The Council’s arrangements

14. The Council’s website states that when a person contacts it about an assessment of their needs, one of its trained adult social care practitioners will complete an initial assessment. After the assessment the social care professional will agree with the person the services that will meet any needs identified by the assessment. They will then work with them to develop a care and support plan.
15. The Council’s Community Mental Health Team (CMHT) is provided jointly by the Council and the local NHS Foundation Trust. Referrals for support to the CMHT are assigned to the most appropriate service to meet that person’s needs. The team includes mental health, medical and social care staff. The assessor works with the person to develop a plan to meet their health and social care needs.
16. The Council and the CMHT share a case recording system to document their contact with people accessing the services and their assessments and subsequent care plans.

What happened

17. Ms X contacted the Council at the end of August 2022 and asked for an assessment of her social care needs. She said she had neurodivergences, mental and physical health issues. She said she struggled with some daily tasks including shopping, making meals, maintaining her home and meeting family and friends.
18. The Council said it considered Ms X’s request for assessment, contacted her in mid-September and confirmed she was receiving support from the CMHT. It decided the CMHT should complete the assessment in September and passed the referral to it at the end of October 2022.
19. Ms X contacted the Council in February 2023 and said she had not heard anything about an assessment. The Council contacted the CMHT.
20. The CMHT officer (Officer 1) visited Ms X a week later. Ms X states they discussed her concerns and Officer 2 promised to arrange support for finances, debt, and housing. The record of the assessment by Officer 1 was three sentences and stated ‘[Ms X] requires support to manage her day to day living’.
21. Ms X experienced a mental health crisis and was admitted to a health provision for mental health support. Upon her discharge at the end of March 2023 Ms X contacted the Council again twice. She said she had not heard anything since the visit in February 2023. Ms X said the Council was not able to provide her with any information.
22. Ms X states Officer 1 contacted her by phone and said they had completed the assessment but had forgotten to progress it. The Council has no record of that call.
23. In mid-April a new CMHT officer (Officer 2) visited Ms X at home and discussed Ms X’s needs and the Care Act assessment.
24. Officer 2 completed the assessment with Ms X in mid-May 2023. It concluded Ms X would benefit from a package of care in her own home for 11 hours per week. The assessment recorded a recovery support worker was supporting Ms X following her mental health crisis with debts, finances and daily tasks. It recorded that debt was causing Ms X a considerable amount of stress. The assessment said without support there was a significant and ongoing impact on Ms X’s well-being. The assessment said Ms X was unable to carry out some activities including:
• Managing her nutrition.
• Managing her day to day living.
• Developing and maintaining relationships.
• Accessing and engaging in work, training, education or volunteering.
• Making use of necessary public services and facilities.
25. The Council said it signed off the assessment in early July and began trying to find a suitable care provider at the end of August by sending a summary of the details to providers and inviting responses. By the end of October the Council had received one negative response. It then contacted five other providers in early November 2023 and identified a provider as a result. The Council said Ms X began to receive the care to meet her assessed needs on 20 November 2023.

Complaints

26. Ms X complained to the Council in August 2023. She said:
• The Council had delayed in completing her care assessment and Officer 1 told her in March they had completed the assessment but that was not the case. Ms X wanted an explanation of the delay, and for the assessment to be done.
• She had explained her poor financial situation and the significant impact it was having on her mental health and Officer 1 promised support for finances, debt and housing in February, but Ms X had never received any.
• Officer 1 did not properly assess her needs and only considered her mental heath issue and not her neurodivergent conditions, and officers should receive further training on that matter.
• The communication between the CMHT and Council’s adult social care (ASC) was poor and should be improved to ensure people were not left waiting for assessments.
27. The Council responded and accepted it had significantly delayed assessing Ms X’s needs, and the reason was unclear. It apologised for the distress caused to Ms X. It said it was currently developing neurodivergent strategies and providing training for all staff.
28. Ms X asked the Council to consider her complaint further. She said it had not addressed all the issues. She reiterated she wanted to know why the delay happened and asked for further information on the training it was providing staff. Ms X said the Council had not commented on the communication between CMHT and ASC and she wanted to know if they had communicated about her case.
29. The Council responded and said Officer 1 had not completed the assessment due to competing demands and staff shortages. It had discussed this with Officer 1 and shared the learning with the rest of the team to improve service. In response to my enquiries the Council could not show how it had shared learning with the team. It outlined the training it had provided its officers around neurodivergences and said it was commissioning additional training for the adult social care teams. It said the services worked closely together where someone was using both services.
30. Ms X told the Council she was still dissatisfied at the end of August with its response as its explanation of “competing demands and staff shortages” was not adequate. Ms X said Officer 1 told her they would make referrals to services for help with managing money and debts in February 2022 which Ms X had told them were a significant impact on her mental health, but it appeared Officer 1 did not record or action this. Ms X said she was still unclear on how CMHT and ASC communicated and how the CMHT would be aware she was waiting for a Care Act assessment while under its care.
31. The Council responded in October 2023 and stated its explanation of the delay in its previous response was sufficient. It said CMHT and ASC work closely together when someone is using both services. It said it had apologised for the delays and had completed the Care Act assessment.
32. Dissatisfied with the Council’s response, Ms X complained to us.

Information from the Council

33. In response to my enquiries the Council said there was no reason for the delay in assessment by Officer 1 other than pressure of work. It said it had already discussed that with Officer 1 prior to the events Ms X complained about.
34. It said the delay between Officer 2 being assigned the case in April and the assessment being signed off in July was due to Officer 2’s inexperience with the system.
35. It said the delay of eight weeks between the assessment being completed in July and it beginning to search for providers at the end of August was inevitable as a referral had to be completed between two departments in the Council. It could then only find a provider when a suitable one became available.
36. The Council said the CMHT officers completed Care Act assessments alongside their role managing a caseload of clients with often complex mental health problems. It said this may be a significant factor contributing to the delay in completing Care Act assessments as CMHT officers have to prioritise their cases based on their levels of risk and need.

My findings

37. When a council commissions another organisation to provide services on its behalf it remains responsible for those services and for the actions of the organisation providing them. So, although I found fault with the actions of the CMHT, I have made recommendations to the Council. The Council can ask the CMHT to assess needs under the Care Act, but it still has the duty to make sure the assessment follows the law and guidance. The Council should retain appropriate oversight to ensure it carries out its duties.
38. The legislation does not say how quickly a council must complete a Care Act assessment. We expect councils to complete assessments in a timescale that is proportionate to the complexity of the issues, and normally within 4-6 weeks. The Council took ten months to complete Ms X’s assessment which was a significant delay. The delay was caused by several factors:
• The Council took six weeks to pass the case to the CMHT after it decided that was the appropriate team to complete the assessment.
• Officer 1 failed to progress the case which was compounded by the lack of sufficient oversight by the Council. The Council was aware Officer 1 had not been progressing cases appropriately yet failed to identify the drift and delay in Ms X’s case.
• The Council transferred Ms X’s case to Officer 2 who it described as being inexperienced, and failed to provide sufficient oversight to ensure the case progressed quickly.
39. All the above was fault and caused Ms X distress and had a detrimental impact on her mental health. I cannot say Ms X’s identified needs would have been the same had the Council acted without fault. However, the evidence shows the Council had assessed and identified Ms X’s eligible care needs by May 2023.
40. The Council delayed in meeting Ms X’s eligible care needs. The Council suggest the delay was ‘inevitable’ however that was not the case. There was a delay of eight weeks between the assessment being completed and the Council seeking providers due to an internal process between two Council departments (assessment and procurement). That delay was excessive and was fault. The Council then did not take any positive action to identify providers beyond sending initial details to providers. When the Council took action to contact providers directly, support was in place within three weeks.
41. Had the Council acted without fault, on the balance of probabilities, Ms X would have received appropriate support for her eligible care needs from mid-June 2023, five months earlier that she did. Therefore Ms X has lost five months of care for her identified needs.
42. The Council’s adult social care team, and the integrated community mental health team share a case recording system. This should be used to record information about contact with people accessing services. Council records, including rolling case records should be clear, complete and contemporaneous. Council officers should be able to access the shared case recording and understand what position a case is in. During this investigation I have reviewed the case records. I did not find evidence of persistent problems in the communication between the two teams
43. However, based on the information available to me I found the case recording was poor for the following reasons:
• The recordings lacked sufficient detail.
• There were significant gaps in the case records for several months at a time.
• There were records made up to five weeks after the event.
• Information was missing. There were no records of telephone calls to and from Ms X.
44. All the above is fault and it leaves uncertainty and frustration for Ms X. It also impacted the Council’s ability to respond to Ms X’s contacts as the case records were not up to date. This gave the impression of poor communication between the two teams.
45. Ms X complained Officer 1 did not complete referrals for support they said they would. There is no record of Officer 1 making any referrals for financial support. There is also no record of Officer 1’s conversation with Ms X about further referrals for support. When Officer 2 completed the assessment it recorded Ms X had support with finances and debts, however there is no record of when or how that support began. Ms X states the referrals were all completed by Officer 2 and the support worker. Due to the lack of case records I cannot make a finding on this complaint even on a balance of probabilities.
46. Ms X complained Officer 1 told her they had completed the assessment of her needs in February when they had not done so. Due to the lack of any records of that conversation I cannot make a finding on this complaint even on the balance of probabilities.

Complaint handling

47. The Council did not respond to Ms X’s complaint about the lack of referrals for support when she raised it, which was fault and caused Ms X distress.
48. Ms X complained the Council did not properly explain the delay in her assessment. The Council’s explanation in its complaint response was limited due to the lack of information in its case recording, which I have already found fault on above. I have provided further explanations on that point in this investigation.

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Agreed action

49. Within one month of this decision the Council will:
• Write to Ms X and apologise for the avoidable frustration, uncertainty and distress and lost care and support caused to her by the identified faults. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The Council will consider this guidance in making the apology I have recommended.
• Pay Ms X a symbolic amount of £500 to recognise the avoidable frustration, uncertainty and distress she experienced.
• Pay Ms X £2,500 to recognise the five months the Council failed to provide support for her identified care needs.
50. Within three months of this decision the Council will:
• Remind staff completing Care Act assessments in both ASC and CMHT of the importance of maintaining clear, complete and contemporaneous case records.
• Review how it retains oversight of Care Act assessments by CMHT to ensure it retains appropriate oversight to avoid drift and delay. As a result of that review the Council will produce a time bound action plan to make any identified improvements within the following three months.
• Review its process for procuring support for care packages from the point of assessment sign off to procurement of appropriate services to ensure there is no unnecessary delay. As a result of that review the Council will produce a time bound action plan to make any identified improvements within the following three months.
• Share the learning from this investigation with the relevant CMHT and ASC teams.
51. The Council will provide us with evidence it has complied with the above actions.

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Final decision

52. I have completed my investigation. I found fault causing injustice and the council agreed to my recommendations to remedy that injustice and avoid the same faults occurring in the future.

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Investigator's decision on behalf of the Ombudsman