Summary: Summary: Mr X complains on behalf of his father the Council failed to complete an assessment in the allocated time which led to him being in an unsuitable setting. Mr X says his family were charged for one-to-one care which he does not believe they should have been. Mr X says this has caused his family distress and they have incurred costs they shouldn’t have. We have found fault in the actions of the Council for failing to advise the likely costs of the care. We recommend the Council apologises and pays a financial payment to Mr X.

The complaint

1. Mr X complains on behalf of his father the Council failed to complete an assessment in the allocated time which led to him being in an unsuitable setting. Mr X says his family were charged for one-to-one care which he does not believe they should have.
2. Mr X says this has caused his family distress and they have incurred costs they shouldn’t have.

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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 significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. If we are satisfied with an organisation’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. I have considered the information provided by Mr X and have discussed the complaint with him over the telephone.
6. I have also considered the information the Council sent in response to my enquiries.
7. Both Mr X and the Council have provided comments on my draft decision. These have been considered before a final decision was issued.

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What I found

8. The Care Act 2014, the Care and Support Statutory Guidance 2014 (CASS Guidance) and the Care and Support (Charging and Assessment of Resources) Regulations 2014 set out the Council’s duties towards adults who require care and support and its powers to charge. The Council also has its own policies.

Assessment

9. The Council has a duty to assess adults who have a need for care and support. If the needs assessment identifies eligible needs, the Council will provide a support plan.
10. The threshold for eligibility is based on identifying how a person’s needs affect their ability to achieve relevant outcomes, and how this impacts on their wellbeing. Council must consider whether:

• The adult’s needs arise from a physical or mental impairment or illness.
• As a result of the adult’s needs the adult is unable to achieve 2 or more of the specified outcomes.
• As a consequence of being unable to achieve these outcomes there is a significant impact on the adult’s wellbeing.

11. The outcomes are:

• Managing and maintaining nutrition
• Maintaining personal hygiene
• Managing toilet needs
• Being appropriately clothed
• Being able to make use of the home safely
• Maintaining a habitable home environment
• Developing and maintaining family or other personal relationships
• Accessing and engaging in work, training, education or
• Making use of necessary facilities or services in the local community
• Carrying out caring responsibilities for a child.

Intermediate Care and Reablement

12. Intermediate care and reablement support services are for people usually after they have left hospital or when they are at risk of having to go into hospital. They are time-limited and aim to help a person to preserve or regain the ability to live independently. The National Audit of Intermediate Care lists four types of intermediate care:

• crisis response – services providing short-term care (up to 48 hours);
• home-based intermediate care – services provided to people in their own homes by a team with different specialties but mainly health professionals such as nurses and therapists;
• bed-based intermediate care – services delivered away from home, for example in a community hospital; and
• reablement – services to help people live independently which are provided in the person’s own home by a team of mainly care and support professionals.

13. Regulations require intermediate care and reablement to be provided without charge for up to six weeks. This is for all adults, whether or not they have eligible needs for ongoing care and support. Councils may charge where services are provided beyond the first six weeks but should consider continuing providing them without charge because of the preventive benefits. (Reg 4, Care and Support (Preventing Needs for Care and Support) Regulations 2014)

Finances

Residential care

14. If a person needs residential care and has capital over the limit of £23,250, the Council is precluded from paying towards the cost of care and the person will have to pay for their own care.
15. Once their capital has reduced to less than the upper capital limit, they only have to pay an assessed contribution towards their fees.

What happened

16. The hospital admitted Mr X’s father in November 2023 after he became confused.
17. Mr X’s father had various assessments at the hospital. The hospital and Council agreed with Mr X’s sister a short stay in a care home to see if his father’s state of confusion settled would be in his best interests. The hospital and Council told Mr X’s sister the Council would complete a further assessment.
18. The Council explained Mr X’s father would have a ‘Discharge to Assess’ bed which would be free of charge whilst he was waiting a full assessment. It said it would not provide the bed for longer than four weeks.
19. Mr X’s father moved into a care home on 2 December 2023.
20. The Council told Mr X an assessment of his father was due to take place in mid-December. However, this did not happen due to increased pressures and staffing issues.
21. The care home contacted the Council in late December 2023 to tell them Mr X’s father had managed to get out of the building. It asked the Council if it could authorise one-to-one staffing to allow it to better safeguard Mr X’s father. This was agreed by the Council shortly after.
22. The Council continued to fund Mr X’s father’s placement and one-to-one care in January and arranged a meeting with his family on 23 January 2024.
23. The Council discussed Mr X’s fathers needs with his family and the notes from the meeting say it was agreed that Mr X’s father needed one-to-one care in his present setting. It went on to say an Elderly Mentally Infirm (EMI) placement may be more appropriate. The Council explained this would remove the need for one-to-one care.
24. The Council discussed funding Mr X’s fathers care with him and the notes from the meeting say Mr X told the Council his father would have to fund his care himself. This was due to having a property to sell and the amount of saving he had. The Council also told Mr X his fathers’ placement would be chargeable from the next day. The Council told Mr X that as his father would be self-funding his care, the family could also seek an EMI placement.
25. The Council continued to complete an assessment of Mr X’s father and a decision was reached on 2 February 2024 that EMI residential care would be approved. As the assessment had been completed the Council advised the care home that Mr X’s father would now be responsible for the fees for his care.
26. Mr X received an invoice for £21,200 requesting a month’s fees in advance from the care home. This was made up of a weekly cost of £5,300.
27. Both the Council and Mr X’s family looked for a suitable setting and Mr X’s father moved to a new placement on 19 February 2024.
28. Mr X’s father has been charged for the period of 2 February 2024 to 19 February 2024.

Analysis

29. The Council agreed with Mr X’s father and family it was in his best interests to move into a care home for a short stay. The Council told the family it would fund this for four weeks.
30. Mr X says the placement his father was unsuitable but the purpose of the ‘Discharge to Assess’ bed was to allow his father to leave hospital and for a further assessment to take place. At the point Mr X’s father moved in the care home it assessed it could meet his needs. I have not found fault in the decision to place Mr X’s father in the setting the Council did.
31. Mr X’s fathers needs then changed and the care home and Council took action to ensure it met those needs until the assessment had been completed. The Council agreed this with Mr X’s family.
32. Mr X says the Council delayed the assessment which meant the family were charged for one-to-one care when they should not have been. I accept the assessment was not completed within four weeks of Mr X’s father moving to the care home. However, the Council extended the funding for Mr X’s father until the assessment was complete. Had the assessment been completed sooner it is my view, on the balance of probabilities, Mr X’s father would have been liable for the charges sooner.
33. While I can see the Council told the family Mr X’s father would be liable for his care in January 2024, I cannot see it told Mr X what the charges would be. This is fault.
34. Had the family been told of the charges they may have chosen to place Mr X’s father in a different setting sooner. However, I cannot say a place would have been available at that time and as such the charges could have always been payable by Mr X’s father.
35. I understand there is no dispute about the quality of care the care home provided to Mr X’s father. But Mr X and his family have been left with the feeling that had they received the information on costs from the Council they could have taken different action. This which would be distressing for Mr X and his family. There was fault by the Council in failing to inform Mr X of the costs, which caused uncertainty about whether there was a loss of opportunity to move his father sooner.

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Agreed action

36. Within one month of a final decision, the Council should:

• Write to Mr X to apologise for the faults identified.
• Pay Mr X £500 for the distress caused by failing to provide the full information about the likely costs of the care.
• Remind staff in writing of the importance of providing full information about the likely costs of care.

37. The Council should provide us with evidence it has complied with the above actions.

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Final decision

38. I have found fault in the actions of the Council for failing to provide the likely costs of his father’s care.

Investigator’s final decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman