Summary: Mrs X complained that the Council has failed to provide her mother with additional care hours during the week and failed to provide a sit in service at the weekend. We find the Council was at fault for failing to complete a carer’s assessment. This caused significant stress to Mrs X. We make several recommendations to address this injustice caused by fault.

The complaint

1. The complainant, Mrs X, complains that the Council has failed to provide her mother with extra care hours during the week and failed to provide a sit in service on the weekend. Mrs X said because of this, she gets no time to herself and said she cannot leave her mother alone.

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The Ombudsman’s role and powers

2. 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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. 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

4. I spoke with Mrs X about her complaint. I considered all the information provided by Mrs X and the Council.
5. Mrs X and the Council had an opportunity to comment on my draft decision. I considered their comments before making a final decision.

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What I found

Assessment

6. 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.
7. 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.

Carer’s Assessment

8. 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.
9. 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)

Carer’s Budgets and Respite

10. The Care Act 2014 says the council may meet the carer’s needs by providing a service directly to the adult needing care. The carer must still receive a support plan which covers their needs, and how the council will meet them. The carer’s personal budget must be an amount that enables the carer to meet their needs to continue to fulfil their caring role. It must also consider what the carer wishes to achieve in their day-to-day life. Part of the planning process should be to agree how the carer will use the personal budget to meet their needs. (Care and Support Statutory Guidance 2014)

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. 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.

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.

What did happen?

13. This section sets out the key events in this case and is not intended to be a detailed chronology.
14. Mrs X’s mother, Mrs Y, returned to live with her in July 2021. The Council completed an assessment of Mrs Y’s needs in March 2022. The package of care included morning, tea and evening care calls, two days at a day centre and six weeks respite.
15. The Council’s notes stated the package of care may be able to be reduced if Mrs Y was deemed safe to mobilise and complete transfers on her own.
16. Mrs X told the Council in May 2022 that her and Mrs Y required more support.
17. The Council completed an assessment of Mrs Y’s needs in the same month and updated her care plan. It referred Mrs Y for an occupational therapy (OT) assessment and Mrs X for a carers assessment. It was agreed that the package of care would now include AM, lunch and evening care calls. It also included a sit in service on a weekend and respite care.
18. In June 2022, the Council agreed to increase the lunch call. This was because Mrs X had requested additional hours due to her own health needs and as she said Mrs Y needed more support.
19. The Council carried out a review of Mrs Y’s care in July 2022. The Council’s notes stated it identified that Mrs Y did not require support over a 24-hour period as Mrs X had requested a 24-hour nurse in the house. It was noted that Mrs X had said she was unsure if she could care for Mrs Y at home and discussed other options. The Council also stated the sit in service on a weekend would end.
20. The OT report was finalised in August 2022 and Mrs Y’s mobility was observed indoors and outdoors. The report states Mrs Y was observed to walk using a walking stick, use the stair lift and bed transfer independently but with effort, using the equipment for support. The report also stated a carers assessment had been requested for Mrs X.
21. Mrs X contacted the Council in September 2022. She said she was struggling to care for Mrs Y and said she would like to access respite care with a view to long term care. The Council agreed to respite, and Mrs Y went to stay in a care home in October 2022.
22. In the same month, Mrs X told the Council she wanted Mrs Y to return home. She said she wanted a package of care in place and said she wanted the sit in service back on the weekends. But the Council said the current package of care was suitable for Mrs Y’s needs. It said it would need to reassess Mrs Y’s needs before it could take any action.
23. The Council visited Mrs Y and Mrs X in November 2022. Mrs Y said she was happy with the package of care in place. This included three days at a day centre. The Council also told Mrs X that the package of care would not change unless Mrs Y’s needs significantly change which Mrs X said she understood.
24. Mrs X complained to the Council in the same month. She requested the weekend support be reinstated. This was because she said she could not spend any time with her children as she said Mrs Y could not be left alone.
25. The Council held a meeting in November 2022 to see how things were since Mrs Y had returned home. Mrs X said things had got worse and stated Mrs Y had been opening doors. The Council said sensors could be put in place for reassurance and offered to refer the family for this. The Council also said the current package of care was sufficient and met Mrs Y’s needs. It also said it had no concerns with Mrs Y being in the house alone.
26. Mrs X told the Council in December 2022 that Mrs Y had fainted and said it was getting more difficult to care for her. The Council stated several actions that needed to be taken before the package of care could be looked at again. This included:
• Waiting to hear back from the GP.
• Visiting Mrs Y at the day centre.
• Requesting further care records.
• Referral to advocacy for Mrs Y.
27. The Council responded to Mrs X’s complaint. It said delays were due to requiring consent from Mrs Y. It said the sitting service was agreed in May 2022 pending a review and OT input. It said this was agreed in response to Mrs X raising concerns about Mrs Y falling. But it said since this time, the feedback obtained is that Mrs Y can walk and transfer independently. It also said Mrs Y was not considered to be high risks of falls following completion of a falls risk assessment at the care home. The Council also said the care had been reviewed several times and stated it might be beneficial to increase Mrs Y’s day centre to four days.

Analysis

28. The Ombudsman’s role is to review council’s adherence to procedure in making decisions. Where a council has followed the correct process, considered all relevant information, and given clear and cogent reasons for its decision, we generally cannot criticise it.
29. In this case Mrs X asked for more support in May 2022 and the Council carried out an assessment the same month, providing more support. In June 2022 after Mrs X asked, the Council agreed to increase the lunch time care call. The Council then held a review of Mrs Y’s care needs in July 2022 and made the decision to remove the sit in service. In September 2022, Mrs X told the Council she was struggling, and it agreed to respite care. When Mrs Y returned home in October 2022, the Council said the package of care would not change unless Mrs Y’s needs significantly changed. The Council then advised Mrs X in December 2022 of a list of actions it needed to take before it could review the package of care. The Council followed the correct process when Mrs X reported concerns for Mrs Y as it either reviewed the care in place or agreed to respite. There was no fault in how the Council reached its decision and I therefore cannot question it.
30. In the assessment completed in May 2022, the Council said it had referred Mrs X for a carer’s assessment. This was also noted in the OT report. I asked the Council to provide a copy of the carer’s assessment. But it has failed to evidence that one had been completed. Whilst Mrs X did receive some respite, the evidence clearly notes that Mrs X had told the Council numerous times that she was struggling to care for Mrs Y. Mrs X told us this caused her significant stress and said she had no time for herself. The guidance states 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. Therefore, this is fault. I cannot say whether a carer’s assessment would have identified further needs for Mrs X but this would have caused her uncertainty.

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Agreed action

31. To address the injustice caused by fault, within one month of my final decision, the Council has agreed to:
• Apologise to Mrs X for not carrying out a carer’s assessment.
• Complete a carer’s assessment with Mrs X.
• Pay Mrs X £150 to acknowledge the uncertainty caused by not completing a carer’s assessment.
32. Within two months, issue written reminders to relevant staff to ensure they are aware of:
33. The statutory guidance which says 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.
34. The Council should provide us with evidence it has complied with the above actions.

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Final decision

35. I have completed my investigation with a finding of fault causing injustice for the reasons explained in this statement. The above agreed actions provide a suitable remedy for the injustice caused by fault.

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Investigator's decision on behalf of the Ombudsman