Summary: Ms Z, on behalf of her sister Mrs X, complained the Council failed to involve them in the assessment of her care needs, failed to provide timely and detailed information about the cost of the assessed care and failed to effectively communicate. The Council was at fault because it did not produce a personal budget and notify Mrs X until four months after the care started and charges were incurred causing distress. The Council has already offered a suitable financial remedy and has now agreed to service improvements and a repayment plan.

The complaint

1. Ms Z, on behalf of her sister Mrs X, complains the Council failed to involve them in the assessment of her care needs, failed to provide timely and detailed information about the cost of the assessed care and failed to effectively communicate.
2. Ms Z says this caused distress which impacted on Mrs X’s physical health.

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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(1), as amended)

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How I considered this complaint

5. I considered evidence provided by Ms Z and the Council as well as relevant law, policy and guidance.
6. Ms Z and the Council had an opportunity to comment on my draft decision. I considered their comments before making a final decision.

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What I found

Charging for social care services: the power to charge

7. A council has a duty to arrange care and support for those with eligible needs, and a power to meet both eligible and non-eligible needs in places other than care homes. A council can choose to charge for non-residential care following a person’s needs assessment. Where it decides to charge, the council must follow the Care and Support (Charging and Assessment of Resources) Regulations 2014 and have regard to the Care Act statutory guidance. (Care Act 2014, section 14 and 17)

Personal Budgets

8. Everyone whose needs the council meets must receive a personal budget as part of the care and support plan. The personal budget gives the person clear information about the money allocated to meet the needs identified in the assessment and recorded in the plan. The council should share an indicative amount with the person, and anybody else involved, at the start of care and support planning. It should confirm the final amount of the personal budget through this process. The detail of how the person will use their personal budget will be in the care and support plan. The personal budget must always be enough to meet the person’s care and support needs.
9. There are three main ways a personal budget can be administered:

• as a managed account held by the council with support provided in line with the person’s wishes;
• as a managed account held by a third party (often called an individual service fund or ISF) with support provided in line with the person’s wishes; or
• as a direct payment.
  (Care and Support Statutory Guidance 2014)

Key facts

10. This section sets out the key events in this case and is not intended to be a detailed chronology.
11. Following a period of time in hospital, Mrs X was discharged into a residential care home on 29 December 2023. It is my understanding this discharge was arranged by the hospital and that it covered the cost for the first two weeks. Mrs X was unwell and did not have capacity to make decisions about her care at that time.
12. The Council completed a review of this placement on 25 January. The Council accepts that neither Mrs X or her family were involved in this assessment. While it is noted Mrs X had delirium and was unwell there is nothing to explain why other family members were not consulted. The Council says it sent a copy of the assessment to Ms Z on 27 February 2024.
13. Mrs X left the care home 8 March, returning to her own home. A package of care was in place to facilitate this. A further assessment of Mrs X’s care needs was conducted on 4 April and Mrs X was fully involved in this assessment.
14. On 3 April, Ms Z had a telephone conversation with the Council about the charges for her care. Notes of this conversation provided by the Council show the discussion was about when charges would apply in respect of the different periods of care provided to Mrs X since October 2023. There is nothing to suggest any discussion took place about how much Mrs X would need to pay for each period.
15. The Council wrote to Mrs X on 24 April providing details of the assessed financial contribution for care received from 13 January onwards. It gave details of the weekly charge for the care home and the domiciliary care received and the amounts outstanding as follows:
• 13 January to 7 March at the care home £415.14 per week, total owed £3,261.81
• 8 March to 30 April for domiciliary care £262.40 per week, total owed £2,024.23
• 1 May onwards for domiciliary care £262.40 per week, to be paid by standing order
16. Mrs X requested a reassessment of her care needs in July, following which the service ended in September. Mrs X made a formal complaint to the Council in June 2024.
17. In its response dated 30 July, the Council accepted it did not involve the family in Mrs X’s assessment in January 2024 and apologised. It also accepted that it failed to have any discussion about the cost of the domiciliary care package at the point Mrs X was being discharged home. It offered to waive the charge for the period 8 March to 3 April, which was £1,012.11. Mrs X indicated she wanted to challenge the amount owed and the Council made a referral to an independent advocate to assist her with this. I have not seen any evidence to suggest Mrs X made further complaints to the Council.

Analysis

18. The Care and Support Statutory Guidance sets out the steps a council must take and the order as follows:
• Assess a person’s needs for care and support
• Decide what needs are eligible for council support
• Assess the person’s financial resources
• Decide whether the Council has a duty to arrange services to meet the needs or whether it will exercise its powers to do so
• Create a care and support plan, to include use of direct payments
• Create a personal budget
• Arrange services or direct payments to meet the needs
19. The guidance says the council must assess the person’s financial resources and any amount the person would be likely to pay towards the cost of meeting the care and support needs once it has decided on eligibility. It says the personal budget enables the person, and their advocate, to exercise greater choice and take control over how their care and support needs are met. It means having clear information about the total amount of the budget, including what amount the council will pay and what amount the person will pay.
20. The information provided shows this process was not followed. This is fault. The family were not included in the initial care needs assessment and the financial assessment was not completed until many months after care had been provided and over £5,000 of costs incurred by Mrs X. Mrs X was therefore not able to make an informed decision about what care would be appropriate and affordable. While it may not have been possible for the Council to have completed a financial assessment sooner, it should still have been able to give general information about the likelihood of needing to make a contribution and an indication of the level of costs.
21. However, I note that after being informed in April 2024 of the cost of the domiciliary care and the amount outstanding, Mrs X did not change the amount of care received. She did cancel the care in September 2024 but I believe that by this time her needs had changed.
22. Although Mrs X was unable to make an informed decision, there is nothing to suggest the financial assessment was incorrect. Mrs X had an opportunity to challenge the amounts but there is nothing to suggest she did this. I note the Council gave consideration to costs such as home insurance, council tax and water rates as required by the guidance.
23. I have found fault and so need to consider what is an appropriate remedy. I note the Council has waived some of the charges however this is not something the Ombudsman normally recommends. Mrs X received the care and the financial assessment is correct. I therefore consider a symbolic payment for distress is appropriate. The amount the Ombudsman would recommend for distress would not be more than the amount already offered by the Council and so I will not recommend a further payment.

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Action

24. To remedy the injustice caused as a result of the fault identified above, the Council will, within one month of my final decision, take the following action:
• Apologise to Mrs X for the fault identified. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisation should consider this guidance in making the apology I have recommended in my findings.
• Reduce Mrs X’s arrears by £1012.11, the amount already offered by the Council if not already done;
• Contact Mrs X to discuss a payment plan to pay the outstanding arrears in affordable instalments; and
• Remind staff either by training session or written guidance to complete and share financial assessments in good time so service users can make informed choices about their care and the costs.
25. The Council should provide us with evidence it has complied with the above actions.

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Decision

26. I have completed my investigation with a finding of fault for the reasons explained in this statement. The Council has agreed to implement the actions I have recommended. These appropriately remedy any injustice caused by fault.

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Investigator's decision on behalf of the Ombudsman