Summary: Mr X complained the Council has unfairly charged him a contribution towards the cost of his care between June 2018 and June 2020. He also complained the Council incorrectly re-assessed his eligible care needs and left him without the support he needs. The Council was not at fault in charging Mr X a contribution towards the cost of his care and support. Nor is there any evidence of fault in the Council’s decision in 2020 that Mr X is not eligible for care and support.

The complaint

1. The complainant, whom I shall refer to as Mr X complains the Council has unfairly charged him a contribution towards the cost of his care between June 2018 and June 2020.
2. Mr X also complains the Council has incorrectly re-assessed his eligible care needs and left him without the support he needs.

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The Ombudsman’s role and powers

3. 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)
4. 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

5. As part of the investigation, I have:
• considered the complaint and the documents provided by Mr X;
• made enquiries of the Council and considered the comments and documents the Council provided;
• discussed the issues with Mr X;
• Mr X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Legislation and guidance

6. Section 9 of the Care Act 2014 requires local authorities to carry out an assessment for any adult with an appearance of need for care and support. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved.
7. The Care and Support (Eligibility Criteria) Regulations 2014 sets out the eligibility threshold for adults with care and support needs and their carers. The threshold is based on identifying how a person’s needs affect their ability to achieve relevant outcomes, and how this impacts on their wellbeing. To have needs which are eligible for support, the following must apply:
1. The needs must arise from or be related to a physical or mental impairment or illness.
2. Because of the needs, the adult must be unable to achieve two or more of the following:
• Managing and maintaining nutrition;
• Maintaining personal hygiene;
• Managing toilet needs;
• Being appropriately clothed;
• Being able to make use of the adult’s home safely;
• Maintaining a habitable home environment;
• Developing and maintaining family or other personal relationships;
• Accessing and engaging in work, training, education or volunteering;
• Making use of necessary facilities or services in the local community including public transport, and recreational facilities or services; and
• Carrying out any caring responsibilities the adult has for a child.
1. Because of not achieving these outcomes, there is likely to be, a significant impact on the adult’s well-being.
8. Where local authorities have determined that a person has any eligible needs, they must meet these needs. When a local authority has decided a person is or is not eligible for support it must provide the person to whom the determination relates with a copy of its decision.
9. Councils can make charges for care and support services they provide or arrange. Where the council has decided to charge, it must carry out a financial assessment of what a person can afford to pay. The council must not charge more than the cost it incurs.

What happened here

10. When Mr X was discharged from hospital in 2018 following a stroke, the Council provided support via its enablement service. Since then, Mr X has had support from a number of care agencies and further periods of enablement support.
11. The Council carried out a financial assessment in July 2018. The Council used information held by the Department of Works and Pensions (DWP) as officers were unable to meet with Mr X. This confirmed Mr X was not required to contribute towards the cost of his care.
12. The Council carried out a further financial assessment in August 2019 as Mr X told the Council the DWP was no longer paying his Personal Independence Payment (PIP). This assessment identified Mr X had received an increase in benefits, backdated to 2016. Based on this assessment the Council advised Mr X he was required to contribute towards the cost of care he had received since 11 June 2018 and sent him a breakdown of the charges.
13. Mr X disputed these charges and has not paid the contribution. He considered his care should be free of charge. The Council confirmed it would carry out a further assessment if Mr X provided the necessary information regarding his income. Mr X states he provided this information, but the Council has no record of receiving it.
14. In August 2020 the Council reassessed Mr X’s contributions as Mr X had provided a bank statement showing his income was different to the information the Council held. The Council confirmed with the DWP that Mr X received a higher amount of Job Seekers Allowance. The previous assessment was therefore incorrect from April 2020. The Council advised Mr X of his new contribution and confirmed this would be back dated to 6 April 2020.
15. Mr X again challenged the Council’s assessment. He asserted the Council should not take account of his severe disability premium when assessing his contribution. The Council advised Mr X it had assessed his contribution in line with the Council’s policies and the legislation.
16. As Mr X’s care package had ended, he was not charged for any further contributions, but had a significant outstanding balance. Mr X maintains the Council’s calculations are incorrect and he should not have to pay for his care.
17. The Council reassessed Mr X’s care and support needs in July 2020 and determined the only outcome he could not achieve was in maintaining personal hygiene. The Council advised Mr X he was not therefore eligible for care and support.
18. The Council had previously determined Mr X need support to:
• manage and maintain his nutrition;
• maintain a habitable home environment; and
• maintain his personal hygiene.
19. The assessment in July 2020 included information provided by the care services who had recently supported Mr X. In relation to Mr X’s ability to manage and maintain his nutrition the assessment states the Council had, on numerous occasions, provided options and recommendations on how Mr X could manage his shopping. The assessment also noted its enablement service had confirmed that during their visits Mr X had prepared his own breakfast and that his freezer was full of ready meals which could be cooked in the microwave or oven. Another in-house team had completed a skills assessment and observed Mr X using the microwave and oven without support. This service also considered Mr X was able to open jars and tins and could choose to purchase peeled and cut up vegetables and meat to prepare his meals. This would reduce the time he had to stand up in the kitchen preparing meals.
20. The assessment concluded Mr X was able to prepare his meals and drinks independently.
21. In relation to his ability to maintain a habitable home the assessment noted Mr X reported an allergy to dust. However, Mr X had not provided any medical evidence of this condition. The assessment noted Mr X’s property was sufficiently clean and maintained to be safe during all visits. Mr X advised the Council a private cleaner was cleaning his flat.
22. The assessment concluded that as Mr X was able to stand for 15 minutes, could walk to his GP surgery, which was 15 minutes away, and had good dexterity, he would be able to complete his domestic tasks independently.
23. The support service’s skills assessment confirmed Mr X was fully independent in managing his money and banking. He did not require support to maintain the occupancy of his home or to maintain amenities such as water, electricity, or gas.
24. Mr X disagrees with the latest assessment and would like his care and support package reinstated. His previous care and support plan provided for 30 minutes support with his personal care and breakfast each morning, and one hour a week to support him in cleaning and maintaining a habitable home.
25. Mr X made a formal complaint to the Council. As the Council did not uphold Mr X’s complaint, he has asked the Ombudsman to investigate his concerns. In response to my enquiries the Council states Mr X was aware he may be charged for his care. A social care worker informed Mr X in May 2018 that he would need to complete a financial assessment to ascertain his contribution towards the cost of his care. The officer gave Mr X a copy of the Council’s Charging for Homecare and Non-residential services booklet and Mr X signed a copy of the charging letter.
26. The Council states it audited Mr X’s account in April 2021 and again accessed the information held by the DWP. This confirmed Mr X had been incorrectly charged for some periods he was receiving care and support. This resulted in a reduction of £1,264.16 to the outstanding balance on Mr X’s account. The Council has written to Mr X apologising for the error and setting out the adjustments.
27. The Council states it is not clear whether the error regarding the incorrect information was made by the Council or whether the DWP had reviewed and adjusted the information held on their system. The Council acknowledges it did not carry out a reassessment when Mr X queried his charge in August 2020. This was an error and a missed opportunity to confirm the information used.
28. Mr X objects to the Council including the Severe Disability Premium in the financial assessment, but the Council states it was correct to include this premium.
29. The Council considers it has taken the correct steps to ensure Mr X’s eligible care needs have been correctly assessed. It states it carried out a comprehensive multidisciplinary review and Mr X received a period of care and support from providers and a period of enablement from the Council’s enablement team. He also received support from the Council’s in-house provision team who completed a skills assessment and provided intensive, short-term targeted intervention. In addition, the Council ensured Mr X had the support of an advocate.
30. It states the care needs assessment in July 2020 took a holistic approach, reviewing all the evidence and feedback provided by carers since 2018. It states the enablement service carried out an assessment on 24 June 2020 and provided Mr X with support between 1 July and 8 July 2020. The service concluded Mr X needed support washing is back and feet but would be able to manage independently with a long handled sponge and bath board.
31. Another service had supported Mr X between 19 July and 23 July 2020. The service advised that during this support Mr X had requested they cook his breakfast rather than support him with his personal hygiene.
32. The in-house provision team then supported Mr X on 30 July 2020 and confirmed Mr X was able to shop on line and could use the oven and microwave. The service also noted Mr X had good mobility and was able to go shopping without using a walking aid and was not out of breath.
33. In response to the draft decision Mr X has reiterated his view that he should not be charged for the care he received. Mr X asserts he has been mistreated by the Council as officers have not listened to him or put his needs first. He states this has caused him great stress and affected his mental health and wellbeing.
34. Mr X states his is struggling to manage his needs, which is adding to his stress. He needs help to wash and with personal care and is only able to eat pre-prepared food. Mr X states has to use two walking sticks due to a problem with his legs and still falls over. As a result, Mr X has gained 50 kg as he is unable to go out and exercise.

Analysis

35. The Council’s Charging policy for Home Care sets out how the Council will assess income. It states that all income paid to the person should be included, except disregarded income, such as the mobility component of PIPs and working tax credits. From this total income the Council will then deduct the appropriate Minimum Income Guarantee/ Protected Income level, and costs such as loan repayments for OT adaptations, rent and council tax. It will also deduct the standard Disability Related Expenditure (DRE) disregard of £17 per week.
36. The figure that is left is the income available for charging and will be used to work out the contribution.
37. In calculating Mr X’s contribution, the Council has deducted the £17 DRE disregard and £151.45 Minimum Income Disregard. This £151.45 is made up of a personal allowance of £91.40, plus the disability premium of £40.35 and the enhanced disability premium of £19.70. It has calculated the remaining income as Mr X’s contribution towards the cost of his care.
38. Mr X disagrees with the financial assessment, but it has been carried out in accordance with the Council’s policy and the relevant legislation.
39. The Council should regularly reassess a person’s ability to meet the cost of their care and any changes in their resources. The Council assessed Mr X’s finances in 2018, in 2019 following a change in his benefits and again in 2020 when Mr X provided his bank statement. It acknowledges it did not review the assessment in 2020 when Mr X again queried his contribution. Had it done so, it may have identified the information it had been using was incorrect sooner.
40. The audit in April 2021 has led to a significant reduction in Mr X’s care charges. But as Mr X has not made any contribution toward the cost of his care since this began in June 2018, even with this reduction, the amount outstanding is still almost £3,500. The Council’s records show it advised Mr X at the outset of the need for a financial assessment to calculate his contribution towards the cost of his care. He will therefore have been aware there was a charge for his care and support package.
41. Mr X also disputes the Council’s decision in July 2020 that he is not eligible for care and support, but this is a decision the Council is entitled to make. The documentation shows the Council has reassessed Mr X’s needs, taking account of his views and the information provided by the services which have supported him. The Council arranged for Mr X to be supported by an advocate, and there is no evidence the Council has not listened to Mr X. There is no dispute that X has difficulties in completing some tasks, but the Council considers that, with appropriate equipment, he is able to manage independently.

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Final decision

42. The Council was not at fault in charging Mr X a contribution towards the cost of his care and support. Nor is there any evidence of fault in the Council’s decision in 2020 that Mr X is not eligible for care and support.

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Investigator's decision on behalf of the Ombudsman