Summary: Miss X complained the Council’s social worker failed to advise her that her mother’s non-residential care would be chargeable. Miss X also complained the bills sent through kept changing and were inaccurate. The Council was at fault for the delay in completing the financial assessment. That fault caused Miss X to be unaware of the cost of care. The Council agreed to reduce the care costs by £479.54 to reflect the delay.

The complaint

1. Miss X complained the Council’s social worker failed to advise her that her mother’s (Mrs Y) care would be chargeable. Miss X says this only became apparent after her mother’s discharge from hospital when bills started to come through for the care charges.
2. Miss X also complained the bills sent through kept changing and were inaccurate. She said the Council is billing for time periods when her mother was in hospital or when care was not received.
3. Miss X says this matter has caused her stress and resulted in her needing to take time off work to follow this up with the Council.

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The Ombudsman’s role and powers

4. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word ‘fault’ to refer to these. We cannot question whether a council’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), as amended)
5. We investigate complaints about adult social care providers. If there has been fault, we consider whether it has caused an injustice and, if it has, we may suggest a remedy. (Local Government Act 1974, sections 34H(3) and (4), as amended)
6. If we are 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

7. I have considered the information Miss X provided. I have also asked the Council questions and requested information, and in turn have considered the Council’s response.
8. Miss X and the Council commented on my draft decision. I have considered their responses before making my final decision.

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What I found

Relevant Legislation and Guidance

9. The Care Act 2014 (the Act) is the legislation that sets out local authorities’ powers and duties in respect of adult social care services. The Department of Health and Social Care also produces statutory supplemental guidance for local authorities on how to discharge these duties. This is called the ‘Care and support statutory guidance’ (the Statutory Guidance).
10. Section 14 of the Act gives a local authority the power, with certain exceptions, to charge for care and support it arranges to meet an adult’s needs.
11. Section 17 of the Act explains that, where a local authority decides to charge for care and support, it must assess the adult’s financial resources to calculate the amount (if any) the adult would be likely to be able to contribute towards the cost of the care and support.
12. In carrying out a financial assessment, the local authority must follow the ‘Care and Support (Charging and Assessment of Resources) Regulations 2014’ (the Charging Regulations). The Charging Regulations set out how local authorities should treat an adult’s income and capital for the purposes of calculating care contributions.
13. The Guidance says that a personal budget should specify the amount the service user will have to pay towards the cost of the care, based on the financial assessment. It explains that a personal budget is the mechanism, in conjunction with the care and support plan, that enables the person to exercise greater choice and take control over how their care and support needs are met.
14. A financial assessment should be completed as soon as reasonably practicable. The Ombudsman would expect a financial assessment to be done within four weeks of a care assessment. A care assessment and financial assessment are part of one process.
15. Paragraph 8.2 of the Guidance says that when a council decides to charge for care it should be “clear and transparent, so people know what they will be charged”.

The Council’s Charging Policy

16. The Council’s policy says that the maximum contribution a person may be asked to pay per week will be 100% of the cost of support or £400, whichever is the lower and subject to their assessed ability to pay.
17. The cost of the support is based on the price the Council must pay the care providers for the service and a person’s contribution should not exceed the Council’s cost.

Background

18. Mrs Y went into hospital on 20 April 2019 following a stroke.
19. A social worker from the Council, Officer A, completed a care assessment of Mrs Y on 19 June 2019. Officer A assessed Mrs Y as having eligible care needs that required support. The care assessment said Mrs Y’s care needs would be met by her family support network and visits four times per day by two carers. Officer A confirmed in the care assessment that Mrs Y would fall into “Band 4” for her personal budget but did not provide an explanation as to what this band meant.
20. Officer A gave Mrs Y and Miss X a financial assessment pack and explained the means-tested nature of social care service. Mrs Y’s son, Mr X, was identified as the person authorised to act on Mr Y’s behalf in relation to her financial assessment but was not present when the financial assessment forms were signed. Miss X signed the Council’s Social Care Financial Assessment consent form for Mrs Y’s care as Mrs Y was physically unable. Miss X says Officer A did not explain the form to her. However, Miss X ticked the following three boxes on the form:
• “A1: Paying for care and support
1. I understand that if I need to pay for my care, the first invoice I receive for the cost of my care will be backdated to the day that care was provided.
2. I understand that if I do not complete a Financial Assessment, I will receive an invoice for the full cost of my care regardless of whether I would be entitled to any financial assistance.
3. I confirm that I have received information on paying for care and support.”
21. This financial assessment form did not confirm the maximum weekly charge the Council applies for care.
22. The hospital discharged Mrs Y on 20 June 2019. The Council put two care providers, Provider A and Provider B, in place to provide Mrs Y’s care.
23. On 24 June 2019, the Council’s finance team spoke with Mr X. Mr X confirmed that Mrs Y had given away assets in excess of £60,000 two months earlier and gifted a property away. The Council advised this was a deprivation of assets and Mrs Y would be self-funded. Mr X son asked if he could appeal this decision. The Council did not tell Mr X the maximum payable contribution in that conversation.
24. On 31 July 2019, the Council completed a financial assessment of Mrs Y. The Council wrote to Mrs Y the following day advising that Mrs Y’s care was chargeable at full cost up to £400 per week.
25. Miss X cancelled the care with Provider A at the start of August. She complained to the Council about it not telling her the care was chargeable.
26. She cancelled care with Provider B at the start of September.
27. The Council issued an invoice to Mrs Y for care provided from June until mid-August 2019. Miss X complained to the Council about this bill.
28. The Council sent Miss X a further bill on 23 October 2019 for care charges up to 15 September 2019. Miss X complained about the accuracy of the billing.
29. The Council issued its stage 1 response in December 2019. The Council’s response did not uphold Miss X’s complaint. It said:
• There was clear evidence Officer A told Miss X there could be charges and that Miss X had signed the consent form.
• It had applied charges for Mrs Y’s care in line with its policy and that cancelled care appointments were still chargeable.
• It had checked the dates that care went ahead with the care providers and revised the invoices for Mrs Y’s care totalling an outstanding balance of £3,292.82.
30. The Council sent copies of the revised invoices to Mrs Y on 7 January 2020. The invoices did not break down the billing to demonstrate the number of hours care provided or the cost per hour of care.
31. Miss X complained further about the new billing as she said they had cancelled various care visits that had been charged for. The Council responded to advise it had checked the cancellations with the care providers and considered the invoices accurate.
32. When Miss X complained to the Ombudsman she said she was not made aware Mrs Y would be charged and believed the Council was charging for care that was not provided.

Analysis

The Council’s right to charge

33. The care records show the family agreed with the care and support plan. The plan included details of the number of care workers and frequency of visits.
34. The Council’s social care notes and care assessment both say Officer A explained to Mrs Y and Miss X that care services are means tested. Miss X has also ticked the box on the financial assessment consent form confirming she had received information on paying for care and support. The Council also confirmed in a telephone conversation with Mr X in June it would charge Mrs Y for her care. Therefore, the Council did tell Mrs Y, Miss X and Mr X that care was chargeable before her mother was discharged from hospital. The Council was not at fault.
35. A person should be provided with all information the Council has available at the time of the care assessment and on signing the financial assessment consent form. The Council was aware on 19 June 2019 that the maximum charge per week is £400. A personal budget should be clear and transparent so that a person can understand the cost of their care.
36. The Council did not explain what care costs might look like for a person with a personal budget in “Band 4”. There is also no evidence the Council told Mrs Y, Miss X or Mr X that the potential cost of care would be up to £400 per week; this was fault.
37. The Council completed the financial assessment on 31 July 2019 meaning it took six weeks to provide Mrs Y with confirmation that her costs would be £400 per week. The Ombudsman would expect the Council to take no longer than four weeks to complete a financial assessment following a care assessment. This two-week delay was fault by the Council.
38. Once the Council made Mrs Y and Miss X aware of the care costs, they cancelled Provider A immediately. They did not cancel Care Provider B until September 2019. This shows that had Mrs Y and Miss X been aware of the cost of care for Provider A it would be unlikely they would have agreed to the care. However, since Care Provider B was not cancelled immediately it shows that the family considered this care was needed.
39. To remedy the faults identified The Council should remove the two weeks’ worth of charges for Care Provider A from the overall outstanding balance owed from 17 July 2019 to 31 July 2019 at a total reduction of £479.54.

Accuracy of Charges

40. There were discrepancies within the original billing over the number of hours care the care providers said they gave to Mrs Y. The Council rectified these when it sent out the amended bills on 7 January 2020.
41. Despite the Council sending amended bills I have noted some discrepancies between the care providers’ cancellation record and Miss X’s. Miss X advised that she cancelled 2 hours of additional care with Provider A which has not been taken into consideration within the final billing.
42. Even if these cancellations were taken into consideration within the Council’s billing, the total charges would not fall below £400 per week for any of the above weeks. Therefore, Mrs Y would still need to make the maximum contribution in these weeks.
43. Miss X also says the Council has charged an extra day with Care Provider B costing £22.89. But, based on Miss X’s cancellation record, the Council has undercharged for Care Provider A in the first week by £34.90.
44. Whilst these discrepancies exist, I cannot say whose records of the care contacts are correct. But I can confirm that Mrs Y has not been financially disadvantaged by any discrepancy between either care providers cancellation records and Miss X’s.
45. The Council has calculated an outstanding balance which is accurate.

Clarity of Billing

46. Invoices issued by a council should contain sufficient information so that a person knows what they are being charged for. In line with the Guidance, invoices should be clear and transparent.
47. The Council is sending one invoice covering the cost of care from both care providers. The Council has not provided invoices to Miss X or Mrs Y which demonstrate how many hours of care it has charged for or at what rate. This billing is neither clear nor transparent and simply contains an overall weekly charge. This is poor administrative practice and is fault.
48. This has caused an injustice to Miss X as she has continued to return to the Council to try an identify what hours of care her mother has been charged for. This has caused distress and time in contacting the Council. The Council needs to review its invoices to ensure sufficient information is provided to people receiving invoices.

Agreed action

49. Within three months of the date of our final decision the Council agreed to:
• Apply a reduction to Mrs Y’s outstanding care charge bill of £479.54 to cover the charges for Care Provider A for two weeks from 17 July 2019.
• Apologise to both Miss X and Mrs Y for her avoidable time and trouble and the delay and distress experienced.
• Review the “Social Care Financial Assessment Form” to include the maximum cost of care per week the Council may charge.
• review its invoices to ensure service users receive sufficient information so they know what they are being charged for.

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Final decision

50. There was fault by the Council. As the Council has agreed to my recommendations, I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman