Decision Date: 2 May 2024
Summary: Ms X complained the Council reduced care and support hours for her adult son, Mr Y, without any reassessment of his needs or a review of his care and support plan when he went into supported living accommodation. The Council was at fault which caused Ms X and Mr Y distress and uncertainty. It was made to apologise and pay Ms X and Mr Y a symbolic payment to remedy the injustice caused.
What happened
Mr Y was an adult with learning difficulties, autism and challenging behaviour. In 2022, the Council carried out a mental capacity assessment that said Mr Y lacked the capacity to decide where to live.
In early August 2023, Mr Y was living in a temporary placement at a residential care home, referred to as Care Home 1.
A social worker, Officer 1, carried out an annual review of Mr Y’s care needs. The assessment most notably found that Mr Y needed 15 hours daily two-to-one support for indoors and when accessing the community to control his behaviour. It also found that Mr Y’s needs were met at Care Home 1, and he should stay there until his new permanent accommodation was ready to be moved into.
In mid-September 2023, Ms X, Mr Y’s mother, emailed Officer 1 to ask about funding for care and support in Mr Y’s new accommodation. Officer 1 replied saying Mr Y’s hours would remain the same and that he would continue receiving two-to-one care. The Officer also said that a six-week review would determine if he had settled and his care plan met his needs.
In early October 2023, Mr Y moved to a new self-contained flat in supported living accommodation, referred to as Supported Living 1.
His support was reduced from 15 hours to 5 hours daily.
Three days later, Ms X emailed the Council to complain that Mr Y’s support had been cut without explanation. She said the Council specifically told her that Mr Y’s support would not change and that she only found about the decrease in hours from the manager at Supported Living 1.
Ms X said the cut would increase Mr Y’s challenging behaviour, impact his mental health, and that she would not have supported the move had she known Mr Y’s support hours would be reduced.
Ms X wanted the hours to be reinstated, see evidence to justify the cuts and an explanation as to why she was not consulted.
The Council responded to Ms X’s complaint in late October 2023, most notably saying—
- Mr Y moved into Supported Living 1 with a support package of 15 hours of one-to-one support daily and 5 hours of two-to-one care daily for outdoor activities;
- Mr Y was not receiving two-to-one care as previously commissioned but the new hours met his needs;
- The reduction in two-to-one care did not impact Mr Y;
- Officer 1 told Ms X before Mr Y’s move to Supported Living 1 that his two-to-one hours would be reduced, and this would be monitored and reviewed; and
- The Council apologised if the manager at Supported Living 1 told Ms X of the reduction in Mr Y’s support hours but could not say if that was before or after Officer 1 told Ms X.
Three days later, Ms X emailed the Council saying it had not carried out a new needs assessment before Mr Y’s support hours were reduced and asked the Council to reinstate his 15 daily hours of two-to-one support.
In early November 2023, the Council sent its final complaint response to Ms X. It said—
- Officer 1 confirmed they completed Mr Y’s care assessment in early August 2023; and
- Officer 1 would review Mr Y’s placement before the end of November 2023 to know how Mr Y’s support hours were used and what worked well.
Ms X then contacted the LGSCO, not satisfied.
In late November 2023, six weeks after Mr Y’s move to Supported Living 1, a meeting took place between Officer 1, a social worker team manager, behavioural support practitioner, supported housing scheme manager, Ms X and another family member. The Council said the meeting was Mr Y’s six-week review. Ms X said they discussed concerns about Mr Y’s behaviour, but no action was agreed and the outcome was unclear.
Ms X said following the meeting, the Council said it would update her on Mr Y’s support hours by the end of November 2023, but the Council did not do so.
In mid-December 2023, a family member sent the Council a judicial review pre-action protocol letter asking it to reverse its decision to reduce Mr Y’s two-to-one hours. The Council decided to reinstate the 15 daily two-to-one hours.
Ms X said that because of Mr Y’s reduced hours of two-to-one support, he could not always go out where he wanted to, particularly during the late afternoon. Mr Y also needed encouragement to go out, which would not happen without two-to-one support.
What was found
Mr Y’s move to Supported Living 1 was done without any re-assessment of his needs and what was provided was not in line with his existing needs assessment. This was fault, and consequently caused Mr Y and Ms X distress and uncertainty over whether his needs were being met and whether Mr Y was able to access all his desired activities.
The Council said it would carry out a six-week review to determine if Mr Y had settled into Supported Living 1 and if his care plan met his needs. Although a review meeting took place in November 2023, the Council did not update Ms X on Mr Y’s care needs following the meeting. This was fault too that caused Ms X to be uncertain about what was agreed and about the outcome of the meeting. Following the review meeting, the Council did not issue an updated needs assessment or updated support plan for Mr Y. This was fault and meant the support the Council was providing Mr Y was not in line with his prior and ongoing existing needs assessment and care plan.
The LGSCO asked the Council to apologise and pay Mr Y £500 to acknowledge the uncertainty and distress caused by not providing support in line with his care plan. It would also pay Ms X £300 for the distress and uncertainty caused to her by the Council’s failure to keep her updated and by Mr Y not receiving appropriate support in line with his care plan.
Points to note for councils, professionals, people using services and their carers, advocacy groups, members of the public
The decision underpins the importance of Councils acting in compliance with their obligations under various statutory provisions, public law and community care law principles and the statutory guidance.
Even so, its findings do not directly refer to the relevant statutory provisions, instead leaving the reader to draw connections with the sections of law and guidance included under the decision’s Relevant Law and Guidance heading.
Section 9(1) of the Care Act 2014 states that where it appears to a local authority that an adult may have needs for care and support, the authority must assess whether the adult does have needs for care and support, and if the adult does, what those needs are. The LGSCO does not spell out that this obligation to assess can arise when there is a drastic change in an adult’s living conditions, such as a transition from a temporary placement at a residential care home to a self-contained flat at supported living accommodation. Such a transition engages section 27(4) of the Care Act 2014, which applies where a local authority is satisfied that circumstances have changed in a way that affects a care and support plan or a support plan. The authority must carry out a proportionate re-assessment and do another round of care planning as if acting under s24 and s25, taking all reasonable steps to reach agreement.
It becomes especially crucial for such an assessment to take place in the context of an adult with learning difficulties, autism and challenging behaviour, making them particularly vulnerable to disruptive changes to their lifestyle.
The suitability of a person’s accommodation – existing or proposed – is an explicit aspect of the features of wellbeing under section 1 of the Care Act. The requirement to promote wellbeing applies on a re-assessment just as much as at the point of the original assessment.
Section 27 of the Care Act 2014 more generally requires Councils to keep care and support plans under review. This is further reinforced by the government’s Care and Support statutory guidance saying that Councils should review plans not less than every 12 months.
Section 27(4) requires Councils to revise the care plan when finalised. All of these obligations are crucial as they ensure relevant parties are not left uncertain about what has been agreed after such meetings, by Panels or other higher decision-makers. It’s easy for people to think that the very pleasant and warm social worker who seemed so supportive has actually MADE a decision at such a meeting, but in fact it is more often the case that the recommendation by the professional needs to be ratified at a senior level.
If you are affected by the issues in this report, please consider asking us a free One-off Question, at a level of principle, here.
The full Local Government Ombudsman report on the actions of Lewisham Council can be found here: https://www.lgo.org.uk/decisions/adult-care-services/assessment-and-care-plan/23-013-092