The Ombudsman's final decision
Summary: Mrs X complained on behalf of Mrs B, the Council failed to properly assess her care needs and provide enough support to meet her needs since she was discharged from hospital. We found no fault in how the Council assessed and reached its view Mrs B did not have enough eligible care needs. We cannot therefore criticise the merits of its decisions and the amount of discretionary support it decided to provide.
The complaint
The complainant, whom I shall refer to as Mrs B, has an advocate (Mrs X) acting on her behalf. Mrs X complained the Council failed to properly assess Mrs B’s care needs and provide enough support to meet her needs when she was discharged from hospital.
As a result, Mrs X said Mrs B experienced distress and had a loss of continuous care support since July 2021.
The Ombudsman’s role and powers
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) We consider whether there was fault in the way an organisation made its decision. If there was no fault in the decision making, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended) 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)
How I considered this complaint
As part of my investigation, I have: considered Mrs B’s complaint and the Council’s responses; offered Mrs B and Mrs X a call to discuss the complaint; considered the information the Council provided in response to my enquiries, including its care assessments for Mrs B; and considered the law and guidance relevant to the complaint.
Mrs B, Mrs X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.
What I found
Law, guidance and policies The Care Act 2014 and the Care and Support Statutory Guidance 2014 set out the Council’s duties to adults who require care and support.
Assessment and care plan The Council has a duty to assess adults who appear to have a need for care and support. If the needs assessment identifies eligible needs, the Council will provide a support plan which outlines what services are required to meet the needs.
The Council aims to commence a needs assessment within 28 days of receiving a referral.
Eligible needs The threshold for eligibility is based on identifying how a person’s needs affect their ability to achieve relevant outcomes, and how these impacts on their wellbeing. Councils must consider whether: the adult’s needs arise from a physical or mental impairment or illness; as a result of the adult’s needs, the adult is unable to achieve two or more of the specified outcomes; and as a consequence of being unable to achieve these outcomes there is a significant impact on the adult’s wellbeing.
Specified outcomes The outcomes are: Managing and maintaining nutrition; Maintaining personal hygiene; Managing toilet needs; Being appropriately clothed; Being able to make use of the home safely; Maintaining a habitable home environment; Developing and maintaining family or other personal relationships; Accessing and engaging in work, training, or education; Making use of necessary facilities or services in the local community; Carrying out caring responsibilities for a child.
Administering or supervising medication is a health need not a social care need. In practice, a care worker may supervise a person’s medication if they are making a care call to meet other eligible social care needs. However, it is not an eligible need in its own right.
Reablement service The Council has a reablement service which it may offer to individuals who has been assessed as not eligible for care support, or in circumstances where their needs are considered to be short-term.
What happened Mrs B had a stroke in 2020 which left her paralysed on one side of her body. She had difficulties with walking and uses an elbow crutch. She also has memory problems and suffers from fatigue.
In March 2021 Mrs B was discharged from hospital following her stroke. As she had nowhere to stay, the Council placed her in a bed and breakfast hotel.
A week later, the Council considered Mrs B’s entitlement to recourse to public funds. It found due to her status in the UK she was not entitled to public funds, but it, and the local council, agreed to provide her with a short term supported living flat for six weeks.
As Mrs B had applied for her status to remain in the UK, the Council decided to exercise its discretion to extend its short-term funding for her sheltered accommodation flat.
In summer 2021 Mrs B received her right to remain in the UK status, which meant she was entitled to receive support from public funds.
The Council assessed Mrs B under the Care Act. It found she did not have enough eligible needs for support. So, it arranged for its reablement service to work with Mrs B to improve her ability to manage her daily life independently.
In Autumn 2021 the Council did a further assessment of Mrs B’s needs. It again found she did not have enough eligible needs for support. However, it decided to provide her with some funds to pay for the cleaning of her flat until she had an income from her benefits.
The Council’s reablement team visited Mrs B again but found her needs had not changed, and she was not entitled to funded support to meet her needs from the Council. It said this was because she could manage daily tasks independently and had help from friends and family.
In late autumn 2021 a manager from Mrs B’s sheltered accommodation raised concerns about her ability to manage her daily needs independently, as it had had to provide her with some support.
Mrs X complained to the Council and asked for a review of the Council’s Care Needs Assessment of Mrs B’s. She said Mrs B needed help with: maintaining personal hygiene; being appropriately clothed; and maintaining a habitable home environment.
In response the Council found it had properly assessed and considered Mrs B’s needs. It told her it had found she did not have enough eligible needs to entitle her to support. However, as she disagreed with its view, it arranged for an occupational therapist (OT) to assess her.
In late 2021 the Council’s OT assessed Mrs B and upheld the Council’s view but made a recommendation she would benefit from a more permanent accommodation to meet her current and future needs.
In early 2022 the local council told Mrs B it was going to move her back to a bed and breakfast accommodation until a permanent accommodation could be found for her.
An NHS OT, who had supported Mrs B’s rehabilitation, asked the Council to reconsider her move to the bed and breakfast accommodation due to the difficulties this would cause Mrs B. The concerns included no fridge, the distance to the nearest laundry facility, heavy doors. The OT also believed Mrs B had eligible support needs for personal hygiene, maintaining a habitable home and she struggled with managing her finances.
The Council assessed Mrs B’s care needs again in her bed and breakfast accommodation. It found she had some short-term eligible needs for help with: Managing and maintaining nutrition, which it found its Meals on Wheels Service and further support to do online shopping with its Reablement Service would resolve; Personal hygiene, which could be addressed by its Reablement Service and Mrs B’s equipment; Maintaining a habitable home environment, which was not needed as her room was cleaned in the accommodation; Family and community, which she could do with help from her church and short-term support from care workers. This included laundry and shopping in the community; and Feeling and keeping safe, which would be addressed by its Reablement Service and the care workers.
After a few days of reablement support, the Council said Mrs B told its social worker she was independent and did not need the support. The Reablement Service also found she could manage with the guidance it had provided her and the equipment she had available to meet her needs.
The Council’s OT assessed Mrs B again to determine her housing needs. It was found she needed a one-bedroom ground floor property, or a property with a lift, with a good size shower room to enable her to use her equipment. The OT also suggested she may need a small package of support to access the community.
The NHS OT who supported Mrs B, asked the Council to review the case as she found Mrs B needed more help than the Council and its OT had assessed. She said she was concerned about her ability to get and take her medication and believed Mrs B may end up in hospital again.
Mrs B did not agree with the Council’s view, so Mrs X asked the Ombudsman to consider her complaint about the care she was entitled to and how the Council had assessed her needs.
In response to our enquiries, the Council said Mrs B had been moved into a temporary one bedroom adapted ground floor flat with level access shower in March 2022, which had cooking and laundry facilities. Its social worker had visited Mrs B and found she was able to manage independently with the equipment her NHS OT had provided. As she had no further assessed care needs her case had been closed.
Analysis Mrs X said the Council failed to provide enough support to Mrs B since July 2021, and it had failed to properly assess her care needs.
Assessment of needs The Council found Mrs B did not have enough long-term care needs and she was therefore not eligible for care support. The evidence shows it assessed Mrs B on four occasions since Summer 2021. It also; considered the views of its Reablement Service which worked with her on in Summer 2021 and in early 2022; arranged and considered its OT’s view of Mrs B care and support needs; considered the views of its OT for housing, and Mrs B’s NHS OT; and Mrs B and Mrs X’s views.
It is clear Mrs B’s NHS OT disagreed with the Council’s OT’s assessment, and its view she did not have enough eligible long-term care needs. It is not for the Ombudsman to reach a view of which professional opinion is correct. In such circumstances, we expect the Council to consider the views it received. Once it has done so, it is then entitled to reach its own decision.
I found the Council had properly assessed and considered the views it received from Mrs B, Mrs X, and professionals. It therefore reached a decision it was entitled to make, and without fault in the process, I cannot criticise the merits of its decisions.
Care support The Council found Mrs B was not eligible for care support. However, it: used its discretionary powers in 2021 to provide her with reablement support, a temporary sheltered accommodation and funds for cleaning, and its meals on wheels service; and has since placed her in a temporary accommodation flat which it found more suitable to meet her daily needs.
I found the Council was not at fault for failing to provide Mrs B with enough care support. This is because it was not under a duty to provide Mrs B with care support. However, it properly considered her short-term needs and decided to offer some limited support to assist her until her immigration status, welfare benefits and her housing situation was resolved.
Final decision
I have completed my investigation with a finding of no fault by the Council.
Investigator's decision on behalf of the Ombudsman