Council breached Care Act in delaying assessment, not issuing plan and charging for intermediate care

A local authority breached the Care Act 2014 when it failed to assess a woman’s needs for several weeks, produce a care plan when she was deemed eligible or provide her with free intermediate care, an investigation has found.

In a report, the Local Government and Social Care Ombudsman said Durham council’s failings caused the woman, who has mental and physical health problems, “avoidable distress and inconvenience”.

Durham has accepted the ombudsman’s judgment and agreed to the report’s recommendations to apologise to Mrs X, pay her £300 and review council care planning procedure.

Delayed assessment

Mrs X contacted the council on 28 June 2019, describing her medical conditions and explaining she couldn’t sleep, didn’t like to go out and struggled to get dressed, use her wet room, or do housework. The council sent Mrs X information about care providers, cleaning services and a befriending service.

On 17 July, she contacted the council again and said her doctor told her to contact the council’s social care team about her mental and physical health problems and how this impacted her ability to manage her home. She was told to ask her doctor to make a referral to mental health services.

The council received a referral letter from Mrs X’s doctor on 30 July, describing the impact of her health conditions and said she needed a support worker. The council said it was unable to help and that Mrs X would have to fund her own care.

Finally on 9 August, following a joint request from Mrs X’s local MP and doctor, the council referred Mrs X’s case to a social worker to arrange an assessment.

The assessment, on 28 August, found Mrs X had eligible needs for care and support arising from her physical condition as well as depression and anxiety. With reference to the outcomes set out in the eligibility criteria regulations under the Care Act, it found she was unable to:

• Manage and maintain her nutrition.
• Maintain her personal hygiene.
• Make use of the home safely.
• Maintain a habitable home environment.
• Access facilities in the community.

Mrs X’s social worker discussed a care package with her and Mrs X agreed to have a financial assessment to see how much she would have to pay toward her care. She did not want to start any care until she knew the results of her financial assessment.

On 19 September, the council wrote to Mrs X and said she would have to pay £112.75 a week towards the cost of her care, a contribution that upset her. Her social worker agreed to send a funding request to the NHS, who then made a referral to the council for intermediate care (IC) on 18 October.

The NHS assessed Mrs X as struggling to wash, dress, and prepare meals and proposed a care package of 30 minutes’ personal care in the morning twice a week, an extra 15 minutes twice a week for showering, and 40 minutes’ care for evenings meals, washing dishes, and to supervise and encourage mobility. The package was intended to last six weeks.

On 12 November, Mrs X spoke with the council and said she wanted to cancel her intermediate care (IC) package, which she had been unhappy with, to which the council agreed. The council then sent Mrs X an invoice for the IC care package.

Multiple failings

The ombudsman found that Mrs X clearly expressed a need for support when she first contacted the council in June 2019 and this was repeated by her doctor, meaning the council’s first contact service should have referred for an assessment under section 9 of the Care Act “The council has a duty to assess someone who appears to have care and support needs, it did not refer Mrs X for an assessment until it received a request from her doctor and MP.

“While the council did carry out a needs assessment, there was a delay of about six weeks, Mrs X was put to unnecessary time and trouble contacting her GP, her MP, and making a complaint before she got an assessment,” the watchdog said. “That caused added avoidable distress and inconvenience to what was already a distressing situation for Mrs X.”

When the council finally carried out Mrs X’s assessment and identified eligible need for care and support, it did not produce a care plan which was a fault, the ombudsman found, as this is required by section 24 of the Care Act.

Under the Care and Support (Charging and Assessment of Resources) Regulations 2014, intermediate care must be provided free for six weeks, meaning the council was wrong to send Mrs X an invoice for her IC package. While the council waived the fee, this did not take away the distress Mrs X suffered, the watchdog said.

The council accepted it wrongly charged Mrs X for her IC after an administrative error when the care provider was changed. It has cancelled the charges. It also accepted the identified failings on the delay in assessing Mrs X and not producing a care plan when required.

Recommendations accepted

Lee Alexander, Durham County Council’s head of adult care, said the council received the ombudsman’s decision and acted swiftly in ensuring all the actions were implemented.

“We carried out a thorough review of our care planning procedure and have shared the results of this with all staff. All employees who work in the social care direct service have also been reminded of our duty to offer an assessment where there is an appearance of need.

“We have since updated the ombudsman on the steps taken and been informed it is satisfied and considers the matter complete.”