Summary: Mr X complains about the Council’s handling of his care and support needs. He says the Council failed to complete an appropriate care assessment and care plan. He says this means the Council is not meeting his care needs. We have found fault in the actions of the Council for failing to explain how it reached its calculation of the hours offered to Mr X. We recommend the Council issues an apology, pays Mr X a financial payment and completes service improvements.

The complaint

1. Mr X complains about the Council’s handling of his care and support needs. He says the Council failed to complete an appropriate care assessment and care plan.
2. He says this means the Council is not meeting his care needs.

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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 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)
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)

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What I have and have not investigated

6. I have not considered Mr X complaint about the actions of the council between 2020 and 2022, including safeguarding reports made to the Council. These complaints are late and I do not consider there are good reasons to exercise discretion.
7. I have considered Mr X’s complaints from 2023 onwards following a reassessment of Mr X’s needs by the Council.

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How I considered this complaint

8. I have considered the information Mr X has sent to me, and I have discussed his complaint with him over the telephone.
9. I have considered the information the Council provided in response to our enquiries.
10. Both Mr X and the Council were invited to provide comments on my draft decision. Any comments received have been reviewed before a final decision was issued.

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What I found

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.

Care Plan

12. 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.

Charging for social services: the power to charge

13. A council has a duty to arrange care and support for those with eligible needs, and a power to meet both eligible and non-eligible needs in places other than care homes. A council can choose to charge for non-residential care following a person’s needs assessment. Where it decides to charge, the council must follow the Care and Support (Charging and Assessment of Resources) Regulations 2014 and have regard to the Care Act statutory guidance. (Care Act 2014, section 14 and 17)
14. Where a council has decided to charge for care, it must carry out a financial assessment to decide what a person can afford to pay. It must then give the person a written record of the completed assessment. A council must not charge more than the cost it incurs to meet a person’s assessed eligible needs.

Direct payments

15. Direct payments are monetary payments made to individuals who ask for them to meet some or all of their eligible care and support needs. They enable people to arrange their own care and support to meet those needs. The council must ensure people have relevant and timely information about direct payments so they can decide whether to request them. If they do so, the council should support them to use and manage the payment properly.
16. The Care and Support Statutory Guidance sets out how councils should administer direct payments. It states that direct payments arrangements should be reviewed every 12 months, generally at the same time as the care plan review. It should only be terminated as a last resort. Councils should take all reasonable steps to address any situations without the termination of the payment. It should conduct effective, but proportionate monitoring processes to identify any potential problems before a termination is necessary.
17. A council can stop direct payments temporarily in certain circumstances. Where it does so, it should make alternative arrangements to make sure the person concerned has continuity of support for their care needs.
18. Whenever the council is considering discontinuing direct payments it should discuss it with the recipient, their carers and anyone managing the direct payments as soon as possible to explore all available options before making the decision.
19. If the council decides to withdraw direct payments it must conduct a review of the care plan and agree alternative care and support with the recipient, their carer and independent advocate, if they have one.

What happened

20. The Council completed an assessment conversation with Mr X in late June 2023. The Council noted Mr X felt as though he had not been included in the care planning process with previous assessments. It also noted Mr X felt he had been offered a ‘take it or leave it’ approach to what the Council had offered to help him with.
21. The Council found Mr X was eligible under the Care Act following its assessment conversation. The Council’s assessment says based on what Mr X reported to it there was an impact on his wellbeing as a result of physical and mental health.
22. The Council completed a Care and Support Plan for Mr X the following day. This said Mr X was entitled to seven hours per week and a direct payment budget of £104.16. The Care and Support Plan noted the outcomes and achievements Mr X had told the Council in the assessment conversation.
23. A representative raised a complaint on behalf of Mr X with the Council in early August 2023. Mr X said he was unhappy with the Council failing to ask whether the current care and support he was receiving could continue. He also said he was unhappy with the support being offered to him and he felt his wishes had not been considered.
24. The Council contacted Mr X in late August 2023 to say he was entitled to seven hours support and that a direct payment had been approved to cover this.
25. Mr X explained to the Council the following day that he was unhappy with the level of support which had been offered.
26. The Council issued a stage one response to Mr X’s complaint in late October 2023 which said a reassessment had taken place which confirmed Mr X was eligible for services. The Council said it would follow this up with Mr X.
27. Mr X’s representative asked for his complaint to be progressed to stage two a few days later and said the Council had failed to address any of the points Mr X had raised in his original complaint.
28. The Council contacted Mr X in early December 2023 and said it could provide a direct payment for seven hours of care and support. The Council asked if Mr X did not want to consider this would he consider council managed care?
29. Mr X spoke to the Council in early December and explained why he felt the seven hours of care and support offered were not sufficient. He also explained he would want a direct payment rather than council managed services. Mr X also told the Council he felt there was no flexibility in considering his needs and drafting the support plan. He told the Council he would like more say in how the plan is completed.
30. The Council issued a final response to Mr X’s complaint in late December 2023 and said one of its departments was speaking to Mr X about queries surround his eligibility.
31. The Council contacted Mr X in August 2024 to offer a further assessment. However, I understand Mr X declined this and said he would complete his own assessment and create a support plan and send it to the Council.

Analysis

32. The Council completed an Assessment Conversation with Mr X in June 2023. In accordance with Sections 9 and 10 of the Care Act 2014 this involved Mr X and discussed his needs and what he would like to achieve.
33. The following day the Council created a Care and Support Plan which included information provided by Mr X about his needs and outcomes/achievements. The Council assessed that Mr X should receive seven hours per week of care and support and his direct payment amount would be £104.16.
34. I have not been able to see how the Council calculated the number of hours or how it believes this was suitable to meet Mr X’s needs. This is fault.
35. Mr X told the Council he was unhappy with the number of hours of care and supported noted in the plan and asked for the Council to explain how it had reached the figure in his complaint.
36. I have not been able to see the Council has explained how it reached its calculation in response to the complaint raised. Nor can I see that the Council has worked with Mr X to try to resolve the issue with the number of hours of care and support detailed in the plan. This is fault.
37. Mr X explained to the Council during its Assessment Conversation with him that he felt it had not engaged with him during previous assessments. He also said that he wanted to be included in the creating of his Care and Support Plan. When this did not happen Mr X would have been caused frustration.
38. The Council failed to deal with the issues raised in Mr X’s complaint when he raised it which would have caused him further frustration and distress.
39. I understand the Council has offered a further assessment, but Mr X has declined this as he has said he will complete his own assessment and send it to the Council. I have therefore, not recommended this as part of a remedy to Mr X.

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Agreed action

40. Within one month of a final decision, the Council should:

• Write to Mr X to apologise for the faults identified.
• Pay Mr X £250 for the distress and frustration caused by failing to explain how it reached its calculation on the number of hours of care and support he would receive.
• In writing, remind officers to keep accurate records of how decisions were reached.
• In writing, remind officers to issue complaint responses which deal with the issues raised by complainants.

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 for failing to explain how it reached its calculation of the hours offered to Mr X.

Investigator’s final decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman