Summary: the complainant complained the Council failed to properly assess her mother’s care and support needs, or her finances leading to a lack of suitable care and creating a large debt. The Council said it assessed the care and provision needed. The Council said it correctly assessed the service user’s financial contribution, but this was not paid resulting in the debt now on the account. We find the Council acted without fault in assessing the care needs and financial contributions the complainant’s mother needed to pay.

The complaint

1. The complainant whom I shall refer to as Ms X complains the Council failed to properly assess her mother Mrs Y’s care and support needs. This, Mrs X says, resulted in the Council failing to provide proper care and support to meet those needs. Mrs X complains the Council did not correctly assess Mrs Y’s contribution towards the costs of the care provided.
2. The lack of a proper care package Ms X says resulted in Mrs Y receiving less care than she needed. Ms X says this prevented her from starting a new job because she had to continue looking after Mrs Y.
3. Mrs X wanted the Council to recognise it did not provide a care package that met all Mrs Y’s needs.

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The Ombudsman’s role and powers

4. 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)
5. If satisfied with a council’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

6. In considering this complaint we have:
• Spoken with Mrs X, and read the information presented with the complaint;
• Put enquiries to the Council and studied its responses
• Researched the relevant law, guidance, and policy.
• Shared with Mrs X and the Council my draft decision and reflected on comments received before making this final decision.

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What I found

7. Mrs Y had received care support at home through the Council in previous years. Ms X had managed this care support through direct payments. The events the subject of this investigation began in August 2018.

Assessment of Care Needs

8. In 2018 Mrs Y entered hospital and needed support arranged for her before she could leave hospital. Mrs Y, supported by her family, wanted to stay in her own home and receive care support there rather than move to a care home.
9. The Council’s social worker assessed Mrs Y while in hospital on 23 August 2018. Ms X says the social worker told her she would arrange help with preparing Mrs Y’s meals, shopping, and laundry.
10. The social worker noted the current care provider did not have a care worker who spoke the correct language to communicate with Mrs Y. The care provider had offered a male care worker which Ms X felt inappropriate. Ms X had said she wanted to change care provider. Ms X says she reported fourteen incidents of poor care including roughly handling Mrs Y.
11. The Council’s social worker noted Mrs Y needed support with personal hygiene and continence care, preparation of meals, nutrition, medication and safely using and maintaining her home. The care needs assessment decided Mrs Y’s needs could be met at home provided her night-time care needs did not increase. If they did then she may need residential care. The care assessment noted the Council’s social worker had given Ms X advice on direct payments and given her a care directory. The Council’s social worker referred Mrs Y to her GP to review her anxiety. The Council’s social worker referred Mrs Y to the District Nursing service for support with her pressure care, and to a new care provider because they had Punjabi and Urdu speaking care workers. The care assessment agreed Mrs Y needed 34.5 hours of support each week with care workers calling several times a day to deliver the care. The Council provided a personal budget for the care. The Council referred Ms X to an accountant who helps manage direct payments. The Council issued a care and support plan. Ms X says the hours allocated did not enable her to secure help with laundry, shopping, cleaning, or cooking.
12. Between January and February 2019, the Council carried out a further assessment of Mrs Y’s care needs. In this assessment the Council’s social worker noted Mrs Y’s dementia and anxiety had increased. The care provider supported her with a care worker during the night as well as care during the day. Medical professionals said Mrs Y’s living alone may cause an increase in her anxiety. They noted when Mrs Y had company her anxiety reduced. Mrs Y and Ms X told the assessor they would prefer 24-hour care in Mrs Y’s home.
13. The care assessment rated Mrs Y as eligible for a nursing placement due to her care needs. The Council noted Mrs Y’s preference for being looked after at home. Therefore, the Council offered a direct payment to the family to cover care costs. However, the family would need to top up the provision to meet all Mrs Y’s needs because they had declined a nursing home placement. The assessment said Mrs Y needed 35 hours support each week . The Council offered a payment of £155 by direct payment for the family to use towards arranging extra support in the home. The Council added this payment to the personal budget of £750 per week the amount the Council would pay for care in a nursing home.

Assessment of contributions to care costs and Direct Payments

14. Where a resident asks to pay for their care through direct payments the Council will pay into a direct payments bank account its contribution to the costs of care. The resident then pays their contribution towards those care costs into that same account. Any shortfall or failure to use the direct payments for the agreed care purposes may result in action against the resident. The Council may also decide to withdraw direct payments. It would then offer care through a commissioned service where the Council would manage the care and payments.
15. In August 2018, following the Council’s social worker’s referral for non-residential care the Council’s finance assessments team wrote to Ms X. Its letter set out what information the Council needed to complete a financial assessment. The Council says it spoke to Ms X. The Council explained if it did not receive the information it had asked for then it would default to charging the full cost of the care package arranged for Mrs Y.
16. On 15 August 2018, the Council’s social worker met with Ms X and Mrs Y in hospital. On 16 August 2018 Ms X presented some financial information.
17. In September 2018, the Council says it had not received all the information it needed to complete Mrs Y’s financial assessment, therefore the Council contacted Ms X asking for this information. In October 2018, the Council says its financial team spoke with Ms X. They still needed information to complete the financial assessment. The Council says it told Mrs X it needed the information by the close of business. If not received the Council told Ms X it would treat Mrs Y as responsible for the full costs of her care. The Council says it did not receive the information it asked for and so on 24 October 2018 the Council issued a financial assessment confirming Mrs Y had responsibility for all her care charges. The Council set out the charges as being £114.12 per week from July 2018. The letter explained the Council had deducted from the charges any eligible disability related expenses.
18. In response to my enquiries the Council says it funded Mrs Y’s care between November 2018 and March 2020 through a Managed Direct Payment. This enabled Ms X to choose a care provider accredited as a supported living provider but who the Council had not used before. The Council awarded a gross personal budge of £595 per week between November 2018 and March 2019. This increased to £750 between March 2019 to March 2020. Any costs incurred above this sum the family would need to meet.
19. The Council began sending invoices to Ms X as Mrs Y’s deputy for her care to reclaim the payments made for the care Mrs Y received. When Ms X presented further information, the Council responded by sending out a new financial assessment in December 2018. This set Mrs Y’s contribution at £94.50 per week. The Council says it sent the financial assessment by recorded delivery. The Council says it received confirmation from Royal Mail that it had delivered the letter and gained a signature from the recipient.
20. In April 2019, the Council began the annual re-assessment of financial assessments triggered by the start of the new financial year. When the Council reassessed Mrs Y’s finances it found Mrs Y’s benefits had increased. That meant her contribution to her care costs needed review. The Council wrote to Mrs Y on 8 April 2019 setting out the results of her financial assessment. This showed Mrs Y should contribute £142.42 per week towards her care costs backdated to when the benefits had increased.
21. In November 2019 following consideration by the Council of Ms X’s complaint it referred Mrs Y for a re-assessment of her current care needs. The Council says due to a backlog in assessments it placed Mrs Y on its waiting list.
22. The Council re-assessed Mrs Y’s care needs in January 2020. The Council also discussed with Ms X the reduction in the capital held by Mrs Y. Councils must satisfy themselves that any reduction in capital or income results from legitimate use of the capital or income. The Council said it could only re-assess Mrs Y’s finances and change her contribution once it had all the evidence it had asked for, including bank statements that would explain any depletion in capital.
23. Sadly, Mrs Y passed away in March 2020. The Council’s social care team contacted the Council’s finance team for an update on the outstanding contributions towards Mrs Y’s care costs so it could present a final invoice to Ms X.
24. The Council says Ms X managed Mrs Y’s care service between November 2018 to March 2020. The Council says it issued invoices to collect unpaid client contributions to the care costs. With these remaining unpaid, the council sought approval for moving from direct payments to Ms X to the Council taking over and offering a commissioned service in January 2020. Sadly, Mrs Y died before the Council completed this changeover in managing the care.
25. The Council says Mrs Y had not paid the contributions of £122.80 per week for the period October 2018 to April 2019. Similarly, the Council says she had not paid her contribution of £130.65 per week for the period April 2019 to Mrs Y’s death in 2020. The Council says the outstanding contribution for adult social care costs stands at £15,497.50.

Analysis – was there fault leading to injustice?

26. My role is to consider whether the Council followed the correct procedures and considered all relevant information when deciding what care Mrs Y needed and whether to offer direct payments or a managed service. If I find fault I must consider if that caused an injustice and if so, what the Council should do to address that injustice.
27. Direct payments enable families to decide on which care agencies they wish to use. This gives families choice and flexibility they would not have if the Council commissioned and managed the care. Where a family gets into difficulties in coping with the direct payment arrangement councils should consider if they may better serve them by the Council commissioning the care and managing it for them. Ms X’s involvement with managing Mrs Y’s care through direct payments in previous years gave her some experience of the procedure followed including the financial assessment procedure.
28. The time taken to assess Mrs Y’s contribution to her care costs means for that period she could not know and therefore pay her contribution leading to a shortfall and a debt. The Council however could only assess her contribution if it received all the information it needed from Mrs Y or her deputy, Ms X, acting on her behalf. Ms X says the Council asked for information in stages rather than all at once adding confusion and delay to the procedure.
29. The Council says it warned Ms X that if it did not receive information it asked for by certain dates Mrs Y would become liable for the full cost of her care package. It sent a letter explaining that and told her in October 2018 it would charge Mrs Y for the full cost of the service. Therefore, Ms X had notice of the Council’s intention to claim the client contributions.
30. In January 2020, the Council considered moving to a managed care arrangement and ending the direct payments having concerns about the failure to pay contributions. That is eighteen months after the service began in August 2018. Where a resident fails to pay several direct payment contributions, I would expect the Council to review whether it should end the direct payments. After a year I would expect the Council to carry out a review of the direct payments’ arrangement. Part of that review should include considering whether to move to a managed commissioned service. The Council had raised concerns about depletion of capital. That took time to resolve. Adding that to the time taken to gather all the information needed for the financial assessment I find the Council did not delay considering whether to move to a managed commissioned service.
31. The Council assessed Mrs Y’s care needs in August 2018 and January 2019. Those assessments found Mrs Y eligible for residential care but noted her preference for remaining in her home with care support. The assessments show the Council considered her personal care and medical needs. The Council gathered and considered all relevant information when deciding the care needs and provision Mrs Y needed. Therefore, I find it acted without fault in those assessments.
32. The quality of care is the responsibility of the care provider and those commissioning the care which under the direct payments’ procedure means the resident, or those acting for her. If there are problems with care, then the Council may offer help in referring the resident to alternative care agencies. I find the Council not responsible for any failure in care offered by the care provider.
33. The failure to pay contributions to the care costs has resulted in a large debt falling to the family to repay. The Council issued financial assessments setting out the contribution Mrs Y should pay and explained what may happen if she did not. Family’s may query the financial assessment and ask for reviews but should continue paying the contributions while any review is underway.
34. I find the Council acted without fault in assessing Mrs Y’s social care needs. I also find the Council acted without fault in its assessment of Mrs Y’s finances and in considering moving from a direct payments scheme to a managed commissioned service.

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Final decision

35. In completing my investigation, I find the Council acted without fault.

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Investigator's decision on behalf of the Ombudsman