Summary: Ms T complains that the Council failed to tell her she would have to pay for the cost of her care when she needed support following a fractured knee and that the charges are incorrect. She also says the Council delayed in sending her a financial assessment form and invoices. The Ombudsman finds the Council delayed in issuing invoices to Ms T but this did not cause her a significant injustice. The Ombudsman does not uphold the remainder of Ms T’s complaints.

The complaint

1. Ms T complains that the Council failed to tell her she would have to pay for the costs of her care in December 2017 when she needed support following a fractured knee. She says the Council did not send her a financial assessment form until after the care package ended and did not send an invoice until several months after that. Ms T also says she was charged for more hours’ support than she received and that the hourly rate is inconsistent.

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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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. 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

4. I have considered all the information provided by Ms T, made enquiries of the Council and considered its comments and the documents it provided.
5. I have written to Ms T and the Council with my draft decision and given them an opportunity to comment.

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What I found

6. In December 2017 Ms T fractured her kneecap. She was admitted to hospital and the surgical team decided the injury should heal without surgery. Ms T had to wear a cast on her leg and would be non-weight-bearing for at least six weeks.
7. On 20 December 2017 a social worker, Officer X, completed an assessment with Ms T with a view to discharging her home. Ms T felt she needed maximum support when she was discharged as she lived alone and did not feel confident mobilising with a walking frame. Officer X considered Ms T would be at risk of falls, deteriorating mobility, deteriorating personal hygiene, malnutrition and dehydration if she were to return home without support. With Ms T’s agreement, she made a referral for carers to visit four times a day to provide support with personal hygiene, transfers and toileting. The duration of the visits was agreed at: 45 minutes in the morning; 30 minutes at lunchtime; 30 minutes in the afternoon; and 30 minutes in the evening.
8. Officer X’s notes record that she discussed the Council’s charging policy with Ms T and explained that if she had capital over the threshold of £23,500 she would be responsible for paying the full cost of her care. She also recorded that she left a non-residential financial assessment form with Ms T.
9. Ms T was discharged home and the care began on the evening of 22 December 2017. Shortly afterwards Ms T asked for the calls to be reduced to three per day.
10. On 14 February 2018 Ms T contacted the Council saying she wished to cancel the lunch and afternoon calls as her mobility was improving. She also said she wanted to reduce the morning call to 30 minutes because the carer did not stay longer than 25 minutes.
11. Another social worker, Officer Y, completed a telephone review with Ms T who advised her cast had been removed and she could now mobilise and had a walker for support. She was also receiving a daily visit from a worker to support her with recommended exercises. Officer Y agreed it was appropriate to reduce the care package and amend the support plan.
12. During the review, Ms T told Officer Y that carers were only staying for 5-10 minutes but writing down 30 minutes. She also said that, at times, carers did not turn up. The Council followed this up with the care provider which said a member of staff had spoken to Ms T a couple of days previously whilst carrying out monthly telephone monitoring and Ms T told her the carer had not arrived on Sunday. Ms T said this was the only time this had happened. The care supervisor spoke to the carer who said she did visit Ms T but did not check the schedule correctly and arrived too early. She was given a verbal warning and told she must check the schedule in advance and, if unsure, telephone the office for assistance. The care supervisor agreed to arrange more spot checks at Ms T’s home to check timesheets and supervise the carers to prevent this happening again.
13. On 23 February 2018 Ms T contacted the Council stating she wanted to cancel all care as she was now managing by herself and had been signed off by the physiotherapist. The Council closed the care package following the evening call that day.
14. The Council sent Ms T a financial assessment form on 7 February 2018 and she received it on 10 February 2018. She signed it on 24 February 2018 indicating she agreed to pay the maximum charge for the services she received because she did not wish to declare information about her finances. The Council wrote to Ms T on 10 March 2018 following receipt of the form stating that, as she did not wish to disclose income or assets, or may have over £23,250 in savings, she was liable to pay the full cost of the services received.
15. In August 2018 the Council sent Ms T invoices for the care she received between 25 December 2017 and 25 February 2018 totalling £1551.76. The following week it sent Ms T a final notice demanding immediate payment. Ms T made a formal complaint.

Analysis

Financial assessment

16. Ms T says she did not know she would have to pay for her care. The review assessment report completed by Officer Y in February 2018 sets out Ms T’s view, “I am able to manage my own finances and currently have over the threshold of £23,250 in savings. I was not informed by the hospital team about any charges regarding my package of care, and I have only received a financial assessment form on 10 February 2018. I am not impressed on the lack of transparency regarding chargeable services or information on possible waived costs.”
17. However, notes recorded by Officer X on 20 December 2018 state that she had discussed the Council’s charging policy with Ms T and explained that, if she had capital over the threshold, she would be responsible for paying the full cost of her care. The notes also state that she left a financial assessment form with Ms T.
18. Where there is a clear difference between two versions of events, the Ombudsman cannot reach a safe conclusion about precisely what happened in the absence of tangible evidence. The only written evidence I have seen is the social worker’s visit notes which supports the Council’s version of events.
19. Although Ms T clearly does not remember this, on balance, I am satisfied the social worker did discuss finances with Ms T and leave her a financial assessment form as she recorded this on the system notes on the date of her visit. When the completed form was not received, the Council sent a further copy on 7 February 2018.

Charges

20. Ms T says the hours charged do not match the amount of time carers spent at her home. She kept a record of the amount of time the carers spent at her property on each visit. Sometimes this is as little as five minutes. But on each occasion the Council has charged for the full 30 or 45 minute visit.
21. The review assessment report completed by Officer Y in February 2018 says Ms T said, “I am happy with the support I have received from carers, but find that on some occasions they do not turn up, particularly on a Sunday or stay for 5 minutes for each call, but write down that they have stayed for 30 minutes. I have kept my own personal records of how long carers have stayed for each call”.
22. There is no independent evidence to confirm how long carers spent at Ms T’s home on each visit. The carers have each signed the care plan against the date and times they were due to visit but they have not manually recorded the exact time they arrived and left.
23. The Care Provider says the only complaint it received from Ms T was on 16 February 2018 through Officer Y and that, when a member of staff contacted Ms T, she said there was only one occasion when the carer did not turn up. Having investigated, the Care Provider found the carer did attend but earlier than scheduled. It has apologised for this. The Care Provider says Ms T did not raise any concerns with it directly about carers leaving early without her permission.
24. In the absence of independent evidence to show the exact amount of time the carers spent at Ms T’s property, I cannot reach a conclusion on this issue.
25. Ms T says the hourly rate charged is inconsistent. The Council has explained that the Care Provider was a non-contracted provider and the rates agreed with the provider for all service users placed with them between April 2017 and April 2018 were: £12.45 for a one hour call; £9.86 for a 45 minute call; £8.33 for a 30 minute call; and £6.27 for a 15 minute call.
26. I have considered all the invoices together with the hours recorded for the carers visits. The invoice for the period 25 December to 31 December 2017 is correct. Ms T was correctly charged £202.34 for visits totalling 13 hours 15 minutes.
27. The invoice for the period 1 January to 4 February 2018 is correct except that Ms T was charged for two 30 minute visits on 9 January 2018 which did not take place. She was therefore overcharged £16.66 for this period.
28. The charges for the period 5 February to 11 February 2018 are incorrect in that Ms T was charged for 15 hours 45 when she should have been charged for 12 hours 15. She was therefore overcharged by £58.31 for this period.
29. The charges for the period 12 February to 18 February 2018 are also incorrect. Ms T was charged £152.32 when she should have been charged £149.26.
30. The Council has overcharged Ms T a total of £78.03 for the period 1 January 2018 to 18 February 2018 but it has not issued an invoice for the period 22 to 24 December 2017. The charges for the visits carried out during this period total £78.03. So, overall, Ms T has been charged the correct amount.

Delay in sending invoices

31. The Council did not send invoices to Ms T until August 2018, more than five months after she returned the financial assessment form. The Council accepts it could have issued invoices sooner. It has explained the delay occurred during the billing verification processes and has apologised for this.
32. The Council could not issue an invoice without a completed financial assessment so I do not criticise it for failing to issue invoices prior to receiving the completed form in March 2018. However, it should have issued the invoices within a reasonable time after this. Failure to do so was fault.
33. The Council says it is currently reviewing the systems used to raise invoices to avoid this situation occurring in future. I consider this to be a sufficient remedy for any injustice caused to Ms T by the delay in issuing the invoices. I do not consider her injustice was significant because, even if the Council had issued the invoices within a reasonable time after receiving the completed financial assessment form, it would still have issued three invoices at the same time as the care package had ended in February 2018.
34. I find the Council was at fault in sending a final demand to Ms T only a week after sending her the invoices. The Council has explained that this was sent in error and has apologised for this. I consider the Council’s apology to be a sufficient remedy for any injustice caused.

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Final decision

35. I find the Council was at fault in that it delayed in issuing invoices to Ms T, but this did not cause her a significant injustice.
36. I find the Council was also at fault in sending a final demand to Ms T a week after sending her the invoices. The Council has provided an appropriate remedy for the injustice caused by this.
37. I do not uphold the remainder of Ms T’s complaints.
38. I have completed my investigation on this basis.

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Investigator's decision on behalf of the Ombudsman