Summary: Mr B complains about the Council’s involvement in the decision making to put in place a care package for his mother, information provided about the funding and the financial assessment. There was fault as the Council did not complete a written copy of the initial assessment and care plan, there was poor record keeping and an incorrect invoice was sent. The Council has agreed to apologise, carry out further assessments, hold a best interest meeting with the family and carry out a service improvement.

The complaint

1. Mr B complains on behalf of his mother, Mrs C, who lacks the mental capacity to make the complaint. He complains that the Council did not involve Mrs C in the decision making when Mrs C was discharged from hospital and that the family was given wrong information about the charges.

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The Ombudsman’s role and powers

2. 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)
3. 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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What I have and have not investigated

4. I have only investigated the Council’s actions, not the actions of the hospital or any healthcare professionals. The LGSCO investigates local authorities but cannot investigate the actions of the NHS. Complaints against the NHS are investigated by the Parliamentary and Health Service Ombudsman.

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How I considered this complaint

5. I have discussed the complaint with Mr B and I have considered the evidence he and the Council have provided as well as relevant law, policy and guidance.
6. Mr B and the Council had an opportunity to comment on my draft decision. I considered any comments before making a final decision.

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What I found

Discharge from hospital

7. The Health and Care Act 2022 made changes to the practice on hospital discharge.
8. The Department of Health and Social Care issued statutory guidance: Hospital discharge and community support guidance (the National Discharge Guidance) in April 2022 (updated January 2024). This provided guidance to NHS bodies and local authorities on discharging adults from hospital. It said local areas should adopt discharge processes that best meet the needs of the local population. It also said carers and family members should be involved in discharge decisions.

Assessment of needs and care plan

9. The Care Act 2014, the Care and Support Statutory Guidance 2014 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.
10. 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 care plan which outlines what services are required to meet the needs and a personal budget which sets out the costs to meet the needs.

Agreeing the care plan

11. The local authority must take all reasonable steps to agree with the person how the person’s needs will be met in the care plan, before the authority signs off the plan.
12. If the plan cannot be agreed with the person, or any other person involved, the local authority should state the reasons for this and the steps which must be taken to ensure that the plan is signed-off.
13. If a dispute still remains, and the local authority feels that it has taken all reasonable steps to address the situation, it should direct the person to the local complaints procedure. However, by conducting person-centred planning and ensuring genuine involvement throughout, this situation should be avoided.
14. Upon completion of the plan, the local authority must give a copy of the final plan to the person for whom the plan is intended, any other person they request to receive a copy.

Review of the care plan

15. The Care Act 2014 says councils should keep care and support plans under review. The CASS Guidance says councils should review plans at least every 12 months. Councils should consider a light touch review six to eight weeks after agreeing and signing off the plan and personal budget. They should carry out reviews as quickly as is reasonably practicable in a timely manner proportionate to the needs to be met. Councils must also conduct a review if an adult or a person acting on the adult’s behalf makes a reasonable request for one.

Financial assessment

16. Councils must carry out a financial assessment if they decide to charge for the care and support. This will assess the person’s capital and income.
17. The upper capital threshold for eligibility for Council funding is currently set at £23,250. Generally speaking, a person with assets above this threshold will have to pay for their own care.
18. If a person refuses to cooperate with a financial assessment, councils can consider the financial assessment completed on that basis.

Reablement

19. 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. Regulations require intermediate care and reablement to be provided without charge for up to six weeks.

What happened

20. Mrs C is an older woman who has dementia and physical disabilities. She lives at home and was, at the time of the complaint, cared for at home by her adult children.
21. Mrs C was taken to hospital on 21 April 2024 after she fell out of her wheelchair. She had broken her hip and required surgery.
22. Mrs C was ready for discharge from hospital on 1 May 2024. A physiotherapist assessed Mrs C at the hospital and the physiotherapist then made a referral to the Council for a Care Act assessment. The Council said the physiotherapist had said Mrs C’s needs were unlikely to benefit from reablement. The physiotherapist noted that Mrs C was for ‘bed-based care (background of dementia) and therapy follow-up at home to ascertain if service user is able to transfer from bed.’
23. The social worker rang Mrs C’s family on 1 May 2024 ‘to gather information for the assessment’ but was unable to get through.
24. The social worker’s case notes for 3 May 2024 said:
• ‘Assessment carried out on ward with son [Mr K] and granddaughter advocating for [Mrs C].’
25. The hospital discharge report was completed as part of the discharge service which is a multi-disciplinary service (NHS and social care). The report said:
• Mrs C’s mobility and activities of daily living had been assessed and were scored. The outcome was that Mrs C needed full bed-based care. (Note: Mrs C had previously not been bed-based.)
• Mrs C could not be left alone at night and the family had said they would be present overnight.
• Mrs C could not be left alone between carer visits and the family had said they would be present between care calls.
• Mrs C already had some of the necessary equipment in place but would need slide sheets, an air mattress and a bed pan. The family had declined crash mats.
• ‘Family have consented to a QDS DH POC (Note: this means four times a day, double handed package of care), Understand [Mrs C’s] needs have now changed and is currently for bed-based care. Family wants to continue caring for patient and will provide care in between calls.’
26. The report said Mrs C needed a Discharge to Assess (D2A) referral to assess function at home with the aim to identify consistent and safe transfer and to assess for any equipment Mrs C may need.
27. The social worker sent an email dated 7 May 2024 requesting Council funding of the package of support to the Council’s funding panel. The email said Mrs C previously needed the assistance of 1 person but now needed fully bed-based care. She said: ‘The family have indicated that they will like her to be discharged with a four-care call package of care with two carers attending. Family stated that they will continue caring for her and will provide care in between calls.’
28. The manager wrote in an email that she supported the package ‘with a view to decreasing it following therapy input when she leaves hospital, as the 6-week review completed by the Discharge Service.’ The director agreed the package on 7 May and asked for a ‘timely review.’
29. The social worker sent the financial assessment form and charging booklet to the family on 7 May 2024. The letter explained that the Council would carry out a financial assessment to decide whether Mrs C was eligible for financial support from the Council.
30. The charging booklet explained that people who had capital over £23,250 were deemed to be self-funding and would have to pay the full cost of their care. The booklet said that, if a person refused to give all the information the Council needs to complete the financial assessment, they would be charged the full cost of their care. The booklet included information on reablement services which were offered free.
31. Mrs C returned home on 8 May 2024 and the care package was put in place. Mrs C’s son, Mr M emailed the social worker on 8 May 2024 and asked whether the care package could be funded by reablement funding as the family would like reablement funding for Mrs C.
32. The social worker replied by email on 8 May 2024 and said:
• ‘During the assessment I spoke to [Mr K] and [Ms L (granddaughter)] and explained that the service is not free…’
• ‘ I have emailed a copy of Islington charging to you as [Mr K] and [Ms L] stated that you are the oldest and a copy to [Ms L] as well.
• ‘This is not the reablement service as I stated in the meeting, family will have to pay some amount.’
33. Mrs C’s daughter, Ms O rang the Council on 9 May 2024 and left a message stating that she wanted Mrs C to receive reablement funding.
34. The occupational therapist (OT) from Islington Discharge Service visited Mrs C on 13 May 2024 to carry out the ‘therapy assessment of function and equipment needs’. Mr B was present during the assessment. Mr B said Mrs C was managing well with two carers coming in four times a day. He said Mrs C was depressed as she was not able to leave her bed and sit in her chair which she had been able to do previously.
35. The OT said Mrs C continued to need bed-based care and ordered a hoist to transfer Mrs C so that she could sit in her chair.
36. The OT revisited Mrs C on 17 May 2024. Mrs C’s son (notes did not specify which son) was present. The OT tested the hoist and noted it worked well. The plan was for the OT to revisit to demonstrate the hoisting to the care workers. This visit took place on 20 May 2024.
37. Mr B spoke to the physiotherapist on 12 June 2024. The notes said: ‘Care has gone in ok, nil issues.’ Mr B asked whether Mrs C could have physiotherapy to walk again. The physiotherapist discussed the fact that Mrs C was transferred by hoist and often refused to sit out so the physiotherapist concluded: ‘seems unlikely standing is plausible based on referral notes.’ The son said he wanted to try again. The physiotherapist’s response was:
• ‘I advised both that it would be very unlikely to transfer again but I could refer to a team to work on goals to reposition independently in bed and give some exercises for the chair. Both happy with this.’
38. The physiotherapist made the referral on 12 June 2024. The referral said:
• [Mrs C] has been discharged home with a hoist and assistance of two. Since going home she has expressed a desire to do some chair/bed exercises to build up her strength, so she may have more independent bed mobility.’
• ‘Son has asked her to walk again. I have advised that this has been assessed previously and deemed not appropriate as service user declined due to pain – hence the hoist.’
39. Mrs C started to receive physiotherapy sessions after the referral.
40. The Council noted on 27 June 2024 that the previous social worker did not type up her assessment and the care plan and had now left the service. Both documents needed to be completed on the system.
41. The social worker carried out the review assessment of Mrs C’s needs on 4 July 2024. Mr B represented Mrs C on the phone during the assessment, but Mrs C was present in the background. The social worker said Mrs C had a package of support of four visits a day with two care workers. Mrs C needed the support of two care workers for all hoist transfers, washing, dressing, changing her continence pads and toileting. She was cared for in bed. The family supported Mrs C in managing the home, managing her finances, meal preparation, shopping and were present at all times as Mrs C could not be left alone.
42. The social worker recommended that the care plan remain unchanged. The assessment noted:
• ‘[Mrs C’s] family views were that she requires formal support in the form of a package of care to be able to manage the home.’
• ‘Family reported the support has been going on well, and they are happy with the progress they are seeing and the support has met the family’s expectations.’
• ‘[Mr B] did mention the visiting time frequency and asked if the time could be re-adjusted. We both looked at the time and found out the time is reasonably scheduled well to meet [Mrs C’s] needs.’
43. Mr B rang the adult social care team on 12 July 2024 and asked for the social worker to ring him back. He was asking for reablement funding for Mrs C. The social worker spoke to Mr B on the same day and the note said: ‘[Mr B] said request for call back has been made long before he spoke with me and I’ve made him understand that [Mrs C] is not suitable for reablement due to long term care needs.’
44. On 9 August 2024 Mr B completed the financial assessment form on behalf of Mrs C and sent it to the Council. He did not disclose Mrs C’s capital on the form but disclosed her income. Mr B signed the statement that Mrs C agreed to pay the full cost of her care package.
45. The Council completed the financial assessment and wrote to Mrs C on 30 August 2024. The Council said Mrs C would have to pay the full cost of her care package as she had not disclosed her full financial information.
46. Mr B rang the Council on 2 September 2024 and said the family was not informed of the charges and said the family would not have agreed to the package of care if they had been informed. He felt that the care should have been paid via reablement. He said they only completed the financial assessment form in July 2024 and then received the invoice.
47. The Council’s finance officer rang Ms O on 3 September 2024. Ms O said the family was of the view that Mrs C should not pay the charges. The family had never been informed of the charges and the family thought the care package would only last for 6 weeks. She said that the family could meet all of Mrs C’s care needs. The officer said the package of support could be reduced if Mrs C’s family could meet all her needs without the Council’s involvement.
48. The notes said:
• ‘[Ms O] agreed for care to be reduced/stopped however wanted assessment/review to be undertaken and also time to discuss with [Mrs C] and the family before decision can be made in this matter.’
49. The officer set a task for the duty team to obtain the family’s decision on whether to reduce or end the care package. The case should also be allocated to a social worker to determine Mrs C’s needs.
50. The finance officer spoke to Ms O on 3 September 2024 and the note said:
• ‘[Ms O] stated that they have decided to keep the care in place for now as family are currently looking into getting other forms of equipment to support them when/if they wish to stop the care.’
51. The family still disputed the outstanding debt as they felt they had not been informed of the charges but ‘[Ms O] is now aware that due to [Mrs C’s] financial assessment, her assessed charge to cost to contributions is full charge.’
52. Mrs C received a letter dated 4 September 2024 from the physiotherapy team. The letter said the aim of the physiotherapy was to improve Mrs C’s ability to reposition herself in bed and to increase her endurance for sitting in her rising recliner chair.
53. The letter noted that Mrs C had initially made some progress and had been able to be transferred from bed to the chair using a transfer aid rather than the hoist, but this had declined and Mrs C was being transferred with a full body hoist again. The physiotherapy sessions had now ended.
54. Ms O rang the Council on 19 September 2024. She said the family felt that Mrs C’s care needs needed to be reassessed ‘as they would not want to reduce or end care package if placing [Mrs C] at risk.’
55. Mr B complained to the Council on 26 September 2024. I have summarised his complaints and the Council’s responses. Mr B said:
• Mrs C was discharged from hospital and a care package was put in place ‘as to who was responsible for setting this up, we have no knowledge.’
• The family was told ‘informally’ that Mrs C would be on the reablement scheme. Mrs C should have received reablement and Mr B said the referral letter from the physiotherapy service dated 4 September 2024 proved this.
• The family had not been involved in the care planning , never agreed to the care package and it said it was not needed so therefore Mrs C should not have to pay any of the charges.
56. The Council responded to Mr B’s complaint and said:
• The social worker carried out the assessment of Mrs C’s needs at the hospital on 3 May 2024 and involved family members Mr K and Ms L in the assessment. The documents showed the family agreed the care package.
• The social worker had explained to the family what the charging rules were. The social worker explained that the financial assessment would determine the charges and that the service was not free.
• It was good practice for the social worker to provide the assessment of needs and care plan to the assessed person and in certain cases their family and this had not happened. The Council apologised for this.
• Mrs C was assessed in hospital and it was decided she would not benefit from reablement. The social worker had informed the family that Mrs C was not eligible for reablement.
• The letter dated 4 September 2024 showed Mrs C received physiotherapy at the request of Mr B, but this was not part of a reablement package and did not mean that Mrs C was entitled to reablement funding when she left hospital.
57. On 15 October 2024 the family contacted the Council as they said that the Council had never carried out a financial assessment of Mrs C.
58. The social worker carried out the review assessment of Mrs C’s needs on 19 October 2024. Mr B was present during the assessment. Mr B said:
• The care package was put in place without the input from the family.
• The family was challenging the charges. He wanted the Council to send a financial assessment officer to complete the financial assessment form and then the family would decide whether to continue with the care package or to source it privately.
• The family wanted to reduce the care package as the family could cover some of the calls. The social worker said they would make a referral to the OT so that the family could provide safe manual handling. Mr B said that he and one of his brothers worked in care homes so they knew about safe manual handling. The social worker noted that the care package would remain the same until the OT assessment was completed. Mr B would have a discussion with the family to see if other care arrangements could be sourced.
59. There were numerous visits by the OT in the following months where the OT provided training to members of the family and also assessed whether different members of the family were able to provide safe care to Mrs C.
60. The OT visited Mrs C on 25 February 2025 with Mr B present. Mr B said:
• ‘the family wanted to wait to change the care plan until all the children have been trained in manual handling before implementing any changes.’
61. The family cancelled the lunch time visit in March 2025 (temporarily) and fully in April 2025 and the two-handed calls in July 2025.

Further information

62. Mr B said the Council refused to stop the care package and I asked the Council if that was true. The Council said it was the family’s decision to continue the care package, and noted that the family had ended parts of the care package in April 2025 and in July 2025. However, the Council admitted that the care plan had not been updated to reflect these changes so the Council had now made the changes and it said this would result in a lower invoice. The Council apologised for the delay in taking this action and said it would ask the finance team to review the need for a payment plan.
63. Mr B has said that he and his siblings were now in agreement that they would like to stop the care package entirely so I asked the Council whether it would agree that this was a safe decision. The Council said it could support the family’s decision but it would need to consider factors such as Mrs C’s mental capacity to make the decision and it would facilitate a best interest decision which would consider the alternative arrangements the family had made to meet Mrs C’s needs to ensure she would not be put at risk of harm.

Analysis

64. It is not the role of the Ombudsman to carry out an assessment of Mrs C’s needs or say what the care plan should be. That is the role of the Council and other professionals. I have considered whether there was any fault in the way the Council carried out its duties and I have done so by comparing what the Council should have done, according to the law, guidance and policies and what it has done.
65. As I have explained in paragraph 4, I have only considered the actions of the Council but I accept that some of the early decision making was carried out as part of the multi-disciplinary process of a hospital discharge which involved professionals from a health, physiotherapy and adult social care background.
66. The Council has already upheld the complaint that it would have been ‘good practice’ to provide the family with the assessment and care plan. In my view this error was more than a failure to provide good practice. The CASS Guidance says these documents should be provided to the person or their family. The Council’s failure to provide the documents was therefore fault.
67. The fault was compounded by the Council’s failure to write full case notes of what happened and how decisions were made at the hospital and this was further fault. The Council’s record keeping during Mrs C’s hospital stay was poor and this was fault.
68. However, I do not uphold Mr B’s complaint that an assessment of Mrs C’s needs did not take place at all or that there was no involvement of the family. The documents showed that the social worker carried out an assessment of Mrs C’s needs on 3 May 2024 at the hospital and that she involved family members, Mr K and Ms L in the assessment. I do not think that the social worker entered a false record in that respect.
69. Also, the documents that were provided showed evidence of the family’s involvement and their views. The records showed the social worker considered what care the family was able to provide. The family had said it would provide overnight care and would provide care between the visits therefore the Council was not required to provide this.
70. Mr B says the family never consented to the care package and that the care was not required as the family could provide all the support. I can not uphold this complaint as the evidence does not support this. There is evidence the family agreed the care plan in May 2024. And further evidence that the family felt the support package was going well, for example as noted by the occupational therapist during their review on 13 May 2024 and the physiotherapist during their visit on 12 June 2024.
71. I note the Council carried out the six weeks review of the care plan (slightly late in July 2024) and Mr B represented Mrs C. Mr B agreed that the existing support package was working well and there was no indication at this stage that the family disagreed with the care package.
72. There was no indication at all from the records I have seen that the family disagreed with the care plan until September 2024 when the Council informed the family that Mrs C would have to self-fund the care package.
73. And I note that even after Mrs C had been sent the invoices and the family knew what the charges were, the family accepted that the care package should remain in place. The notes of the conversations with the family members on 3 September, 19 September 2024 and 25 February 2025 stated that different members of the family chose to continue the care package until the package could be ended safely and the family carers had been trained in carrying out the tasks that the care workers were carrying out.
74. I note that the family ended the lunch time call for a period in March 2025 and the double handed call in July 2025 after extensive training and involvement from the OT.
75. I agree with the Council that there was fault in the Council’s failure to provide an updated invoice which reflected the lower cost after the care package was reduced.
76. In terms of the reablement, I could find no evidence that Mr B or any member of the family had ever been told that Mrs C would receive reablement funding. And there was evidence (email dated 8 May 2024 and case-note of telephone conversation dated 12 July 2024) that the social worker told the family that Mrs C was not eligible for reablement funding so I have no concerns in that respect. I appreciate that the family wanted reablement funding but the family knew, from the outset, that reablement funding had not been agreed for Mrs C.
77. It is not for the Ombudsman to decide whether Mrs C should have received reablement funding as that can only be decided by the professionals involved in Mrs C. Mrs C was assessed by the physiotherapist (during her hospital stay in May 2024) that she would not benefit from reablement.
78. Mr B says that the referral to the physiotherapy service in June 2024 proved that Mrs C was eligible for reablement. I have read the referral but it only showed that Mrs C was referred for physiotherapy but there was no evidence that this was reablement physiotherapy or that it meant Mrs C was entitled to reablement funding.
79. I do not uphold Mr B’s complaint that the family had not been informed that Mrs C would be charged for the care package. There is evidence that the social worker discussed the charging with Mr K and Ms L in the hospital in May 2024 and the charging information and the financial assessment were sent to the family on 7 May 2024.
80. Mr B knew, when the care plan was set up, that the threshold for Council funded care was £23,250 and therefore knew that, if Mrs C’s capital was more than £23,250, she would have to self-fund her care package. I also note that Mr B did not provide details of Mrs C’s capital when he returned the financial assessment and that he agreed on the financial assessment form dated 30 August 2024 that Mrs C would self-fund her care package so he was aware that Mrs C would be charged for the full cost of her care package.
81. Mr B said the Council had not carried out a financial assessment of Mrs C, but I find no fault in that respect. Mr B did not fill in the capital section of the financial assessment form so therefore the Council could conclude that she had capital over £23,250 and was therefore a self-funder.
82. I accept that Mr B did not find out the actual cost of the weekly charge until August 2024 when he received the first invoice and I make the following comments in relation.
83. The Council did not send out the first invoice until August 2024, but this delay was not the Council’s fault. The Council sent out the financial assessment form in May 2024 but Mr B did not return the form until August 2024. If the financial assessment form had been returned earlier, the family would have received the invoice earlier.
84. However, as I have stated in paragraph 66, I have found fault in the Council’s failure to provide a care plan which would have contained the personal budget in May 2024 and, if the Council had done so, the family would have been better informed of the cost of the care package.

Injustice and remedy

85. When the Ombudsman finds fault, we consider whether the fault has caused any injustice and, if so, how it can be remedied. Mr B is of the view that Mrs C should not have to pay any charges.
86. I have found fault with the Council’s failure to provide a care assessment and care plan in May 2024 and its poor record keeping during the hospital discharge. As the record keeping was poor, I cannot say exactly what was discussed but I am of the view that, overall, the family was involved in the initial decision and the family agreed the care plan. Mr B knew from the outset that, if Mrs C’s capital exceeded £23,250, she would have to self-fund her care package. I note that, even after the family was aware of the actual charges, the family did not end the care package.
87. Therefore, the injustice is limited, but I do accept it made the decision-making process more difficult and stressful for the family which is the main injustice.
88. I recommend that the Council apologises to Mr B, as Mrs C’s and the family’s representative. Further, Mr B says the family is now in agreement that it wants to end the care package and I note that the Council has said, in its reply to the Ombudsman, that it could support this decision. Therefore I recommend that the Council carries out a mental capacity assessment of Mrs C’s ability to make decisions about ending her care package (if it has not already done so) and then holds a best interest decision meeting with the relevant professionals involved with Mrs C and the children of Mrs C to make the best interest decision.
89. I also recommend the Council offers Mrs C a further financial assessment. I do not know what Mrs C’s capital is, but it may well be that, if Mrs C had been paying the invoices from the start, she would have become eligible for Council funding at some point since the care package was started and would have ceased to be a self-funder. This would mean that the outstanding debt may be lower than currently estimated. It would be helpful for the family to have this information when they are making the best interest decision regarding the care package.
90. I note that the Council has agreed to provide a reduced invoice which reflects the already reduced care package and I will include this in the recommended remedy. This invoice may also be affected by the financial assessment so, if the family agrees to a further financial assessment, then the invoice may be provided until after the financial assessment has been carried out.
91. I also note that the Council has agreed to consider a repayment plan for Mrs C so I have included that in the remedy.
92. I have also included a service improvement in relation to the fault that I have identified.

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Action

93. The Council should carry out the following actions within two months of the final decision. It should:
• Apologise to Mr B for the fault that I have identified.
• Carry out a mental capacity assessment of Mrs C’s capacity to make decisions about her care package, if not already done so.
• Hold a best interest meeting with the family and make a best interest decision about the care package as set out in paragraph 88 of the decision.
• Offer Mrs C a financial assessment and carry out the financial assessment if the family agrees.
• Provide an updated invoice for the outstanding debt as set out in paragraph 90.
• Consider providing Mrs C with a repayment plan.
• Ensure that all relevant staff are reminded of the duties to provide the assessment of needs and care plan to the person, or any other person involved and the duty to keep comprehensive records.
94. The Council should provide us with evidence it has complied with the above actions.

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Decision

95. I find fault causing injustice. The Council has agreed actions to remedy injustice.

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Investigator's decision on behalf of the Ombudsman