Summary: Mr X complained the Council failed to reassess the home care package provided to his mother which caused uncertainty about whether it was meeting her needs. We have found fault by the Council in the delay in responding to the reassessment request and in not completing a carers assessment. We consider the agreed action of an apology, symbolic payment and procedural reviews provides a suitable remedy.

The complaint

1. The complainant, Mr X, complains the Council failed to reassess the home care package being provided to his mother despite being told her circumstances had changed. Mr X also complains about the quality of care provided by the care provider on behalf of the Council.
2. Mr X says because of the Council’s fault there is uncertainty about whether the care package was meeting his mother’s needs and she received poor quality care.

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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 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 may investigate complaints from the person affected by the complaint issues, or from someone else if they have given their consent. If the person affected cannot give their consent, we may investigate a complaint from a person we decide is a suitable representative. (section 26A or 34C, Local Government Act 1974)
6. 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.
7. 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

8. I read the papers provided by Mr X and discussed the complaint with him. I have also considered information from the Council. I have explained my draft decision to Mr X and the Council and considered the comments received before reaching my final decision.

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What I found

Background and legislation

Assessment

9. 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.
10. 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.

Care Plan

11. 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.

Reviews

12. Section 27 of the Care Act 2014 says councils should keep care and support plans under review. Government Care and Support Statutory Guidance says councils should review plans at least every 12 months. Councils should consider a light touch review six to eight weeks after agreeing and signing off the plan and personal budget. They should carry out reviews as quickly as is reasonably practicable in a timely manner proportionate to the needs to be met. Councils must also conduct a review if an adult or a person acting on the adult’s behalf makes a reasonable request for one.

Carer’s Assessment

13. 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.
14. 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)

Key events

15. The following is a summary of key events. It does not include everything that happened.
16. The Council completed an assessment for Mr X’s mother towards the end of May 2023. This identified she had eligible needs and a support package of care at home was needed. It was noted Mr X’s elderly father was the informal carer and a carers assessment would take place.
17. The Council confirmed the care package in early June. The Panel assessment document noted an upcoming neurology appointment and suspected condition and a previous speech and language therapy (SALT) recommendation for a soft food diet. It was further noted that respite services would be assessed during a carers assessment
18. The support plan set out four daily calls with two care workers. The allocated time ranged between 30 minutes and 60 minutes for each call. The plan noted Mr X’s mother would ‘freeze’ or have tremors and required prompting and encouragement to move and time when assisted to reduce the risk of dizzy spells related to the impact of medication. The SALT recommendation about a soft diet was also noted.
19. There was a review of the care package towards the end of June. This recorded Mr X’s father as the main informal carer and that a separate carer assessment was needed for him. It was noted Mr X’s father had not been available that day and one would need to be scheduled separately.
20. The care provider advised the Council that Mr X’s mother had been admitted to hospital in early September. She was discharged home in mid-October.
21. Mr X telephoned the Council in mid-January 2024 to say his mother had now received a confirmed diagnosis of a specific neurological condition and required a reassessment of her needs as these had changed following her hospital stay. The Council added this request to its waiting list for an unscheduled review.
22. Mr X emailed the Council in early March to say he had sought a review in January due to the ill health of his father who had been providing his mother’s care but had been diagnosed with terminal cancer himself in February and was receiving hospice care. The Council responded to Mr X to explain his request for a reassessment had been added to the waiting list in January but had not yet been allocated. The Council was not able to provide a likely timescale.
23. Mr X advised the Council towards the end of March that his father had died and his mother had been readmitted to hospital on the same day but had now been discharged home with an end of life plan. Mr X sought an urgent review as the previous assessment was no longer valid. Mr X advised the Council that his mother now required less care visits as she was eating and moving less. The care provider also contacted the Council directly for advice as Mr X had asked it to reduce the number of daily visits. The Council confirmed the current plan should be continued until information from the hospice was received. Mr X’s mother died at home at the end of March.
24. Mr X contacted the Council in mid-April about what had happened. Mr X was unhappy the Council had not responded to his January request for a reassessment of his mother’s needs and that issues about his mother’s inability to swallow and resulting choke risk were not reassessed and suggested the time needed to both help transfer his mother and feed her had needed review due to taking longer. Mr X also said there had been issues with her medication being missed and poor record keeping about her bowel movements.
25. The Council responded to Mr X in early May and accepted fault in that it had not been able to respond to his request for a reassessment due to the demands on the service at the time. The Council asked Mr X to confirm the care workers had attended as contracted during the relevant period and stated it would review the charges following his request of 25 March to reduce the amount of care calls and revise the invoice accordingly. Mr X was not satisfied with the Council’s response and reiterated the care workers had been using an out of date plan to care for his mother. Mr X explained if a review had been completed in January 2024 it would also have identified that he had stopped work to help care for his mother and father as his father had become unwell in December. The Council provided a further response towards the end of May and explained it had made changes to the way its service was provided and was recruiting additional staff to help provide a more responsive review service.
26. The Council has provided the Ombudsman with details of the care worker visits to Mr X’s mother for the period from early June 2023 to towards the end of March 2024.

My consideration

27. As set out above, councils should review plans at least every 12 months and these should be completed as quickly as is reasonably practicable in a timely manner proportionate to the needs to be met. This would also apply to a review reasonably requested outside of the annual review process.
28. Mr X sought such a review in mid-January 2024. This was after his mother had spent over a month in hospital and received clarification about her atypical, rapidly progressing and degenerative neurological condition. There is nothing to suggest the Council did not consider this to be a reasonable request. However, the Council had not completed such a review or provided a likely timescale to Mr X at the time of his mother’s death at the end of March. This is fault. The Council should have acted sooner to establish whether the care plan was properly meeting the needs of Mr X’s mother.
29. Without such an assessment it is not possible, even on balance of probabilities, to decide what care Mr X’s mother should have received but for the fault. Our usual approach in these circumstances is to recommend a prompt reassessment and consideration of a symbolic payment. Sadly, this is not possible as Mr X’s mother has passed away. In these circumstances, we can only consider the impact on Mr X.
30. I am satisfied Mr X will have been caused distress and uncertainty about whether the care provided to his mother was still meeting her needs during what was already a difficult time.
31. The Council also failed to complete a carers assessment for Mr X’s father or develop a support plan for him. This is fault and despite identifying Mr X’s father as the main carer in the original assessment and that he was himself elderly and may require some respite. Sadly, we are unable to provide a remedy to Mr X’s father as he has also passed away.
32. However, I have noted the reassessment requested by Mr X would have identified that he was now the main carer due to his father’s ill-health and as such should have received his own carer’s assessment. This compounds Mr X’s distress about the outcome of a reassessment.
33. Finally, I have seen no evidence Mr X raised concerns about the quality of the daily care being provided to his mother with the Council before seeking a reassessment. The records provided do not suggest that care workers failed to arrive or spent less than the allocated time at the visit. In these circumstances, there are no grounds for me to recommend waiving or reimbursing care fees in addition to those already identified by the Council in its complaint response as set out above.

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Agreed action

34. The Council will take the following action within one month of my final decision to provide a suitable remedy:
1. write to apologise to Mr X for the delay in responding to his request for a reassessment of his mother’s care needs and not keeping him informed about progress or likely timescale;
2. pay Mr X £500 to acknowledge his avoidable distress about whether the care provided to his mother was still meeting her previously assessed needs within one month of my final decision; and
3. issue a reminder to relevant staff of the importance of reviewing care plans in line with the Care Act 2014 and particularly when someone’s needs may be changing rapidly.
35. The Council will also take the following action within three months of my final decision:
1. review its procedures to ensure care plan review requests are correctly monitored;
2. review its guidance to care providers about how to respond to changing care needs and how to initiate reviews of care plans as necessary; and
3. review its procedures to ensure that carers assessments are completed in accordance with the statutory guidance.
36. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisation should consider this guidance in making the apology I have recommended in my findings.
37. The Council should provide us with evidence it has complied with the above actions.

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Final decision

38. I have completed my investigation as I have found fault by the Council but consider the agreed action above provides a suitable remedy.

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Investigator's decision on behalf of the Ombudsman