Summary: Mr B complains the Council did not tell him about care charges when his mother entered a care home and wrongly charged him for her stay. The Ombudsman found fault with the Council causing injustice. The Council failed to provide important information and took too long to carry out a financial assessment. The Council has agreed to take action to remedy the injustice caused.

The complaint

1. Mr B complains the Council did not tell him about care charges when his mother entered a care home and wrongly charged him for her stay. I have referred to Mr B’s mother as Mrs C.

Back to top

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. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

Back to top

How I considered this complaint

4. I considered:
• Mr B’s complaint and the information he provided;
• documents supplied by the Council;
• relevant legislation and guidelines; and
• the Council’s policies and procedures.
• The Council and Mr B comments on a draft decision.

Back to top

What I found

Legislation and statutory guidance

5. The Care Act 2014 provides a single legal framework for adult care and support; it is accompanied by statutory guidance.

Charging

6. Where a council is meeting needs by arranging a care home, it is responsible for contracting with the provider. It is responsible for making sure the provider’s invoices are paid.
7. Usually, the council must recover the full cost of providing residential care to a person with enough capital. People in residential care must contribute all their income less the personal expenses allowance (Charging and Assessment of Resources Regulations 2014).
8. A council must regularly reassess a person’s ability to meet the cost of any charges to take account of any changes to their resources. This should take place if there is a change in circumstance (such as a person entering residential care) or at the request of the person.
9. Care and support planning will identify how best to meet a person’s needs. As part of that, the council must provide the person with a personal budget, except in cases or circumstances set out in the Care Act (Personal Budget) Regulations.
10. The personal budget gives everyone clear information about the costs of their care and support, and the amount the council will pay. This will help people to make more informed decisions.
11. The Council should identify a personal budget in a timely manner, proportionate to the needs to be met. The Council should tell the person where they are in the care planning process, what will happen next and the likely time frames.

Debt recovery

12. Councils should clearly discuss with the person or their representative at the outset that care and support is a chargeable service and where the person has been assessed as being able to afford to do so, they will be required to contribute to the cost of that care. It should also be explained that this means there will be invoices and that an agreement should be reached as to whom the invoices are sent, and if the person wishes, that their agreement and authority is obtained for the use of an agent.

NHS Funding

13. A decision support tool (DST) is used in continuing health care funding decisions. It is a document which records evidence of an individual’s care needs to determine if they qualify for continuing healthcare funding.
14. NHS continuing healthcare (CHC) is a package of care arranged and funded solely by the NHS for individuals who are not in hospital and have been assessed as having a "primary health need".
15. NHS funded nursing (FNC) care is a contribution from the NHS to meet the nursing element of a person’s care if their needs are such they must be met in a nursing home, but do not trigger full NHS funding.

What happened

16. This chronology includes key events in this case and does not cover everything that happened.
17. In January 2018, Mr B’s mother, Mrs C, moved into care home 1.
18. A week later, Mrs C was admitted to hospital. The Council stopped the funding for care home 1. It closed Mrs C’s case because it did not know when she would be discharged from hospital. The Council told the hospital to tell it when Mrs C would be discharged so a care and support assessment could be undertaken and funding agreed.
19. Mrs C was ready for discharge from hospital at the end of January 2018. The hospital arranged for Mrs C to return to care home 1 but did not tell the Council.
20. Two days after Mrs C returned to care home 1, the care home phoned the Council and said it had readmitted Mrs C. The Council told the care home a new care and support assessment should have been undertaken before Mrs C was discharged from hospital. The Council updated Mrs C’s care and support plan and said it would commission short-term care for Mrs C at care home 1.
21. In February 2018, the Council carried out a care and support assessment. The assessment recommended Mrs C was provided with long-term care at a home with nursing and care provision. Mrs C said she would like to move to care home 2.
22. The Council completed a CHC checklist and asked for a DST meeting.
23. Care home 1 sent Mr B an invoice for £6,000. This was the total cost of Mrs C’s care. The care home told Mr B if he did not pay, he would incur interest. Mr B said the Council was liable for the debt. The care home advised him to pay the fees and claim them back from the Council. Mr B paid almost £1,000. Mr B asked the Council to pay the balance of the invoice and repay him the money he had paid.
24. The Council wrote to the hospital. The Council explained the hospital should have sent an assessment notification when Mrs C was ready for discharge. The Council said it did not assess Mrs C or agree to her being placed at care home 1. The Council told the hospital it accepted no liability for the debt.
25. The Council wrote to care home 1 and said it should not have accepted Mrs C without a funding agreement. Care home 1 asked the Council to assess Mrs C for funding retrospectively. The Council said it could not apply for funding to cover the period of the invoice sent to Mr B. This was because social care had not placed Mrs C at care home 1.
26. In March 2018, a DST meeting was held, and Mrs C was considered eligible for FNC funding.
27. In April 2018, Mrs C moved to care home 2 to receive nursing care provision. The Council updated Mrs C’s care and support plan.
28. The Council arranged to visit Mrs C to carry out a financial assessment in June 2018. This assessment was for the period February to April 2018. Mr B told the Council Mrs C had been admitted to hospital and the planned visit could not go ahead. Mrs C passed away in June 2018.
29. The Council carried out a benefit check for Mrs C and used a financial assessment completed in March 2017 to assess the amount she needed to contribute to her care costs between February and April 2018. In June 2018, the Council wrote to Mr B to tell him his mother’s contribution to her care was £144 a week. But in the financial assessment the Council used the wrong income values and care home costs.
30. In August 2018, the Council told Mr B it would pay care home 1’s fees and invoice him for Mrs C’s assessed contribution. It said care home 1 would refund him the money he had paid. Mr B agreed to pay Mrs C’s assessed contribution for care home 1 as he had for care home 2.
31. In September 2018, the Council wrote to Mr B with a recalculation of Mrs C’s contribution to her care; this was £125 a week.
32. Care home 1 refunded the money Mr B had paid.
33. In October 2018, the Council sent Mr B an invoice for £1200. The Council explained this invoice was Mrs C’s assessed contribution towards her care from February 2018 to April 2018. The Council said this period was short-term care while it completed assessments and considered to long-term care options for Mrs C.

Analysis

34. I have not found any evidence the Council gave Mr B or Mrs C information about her residential care status either orally or in writing. There is no evidence the Council told Mr B or Mrs C that her stay in care home 1 was short-term or that depending on the result of a financial assessment, Mrs C would have to contribute to the cost of her care. This is fault.
35. I have also found no evidence the Council gave Mr B or Mrs C information about her personal budget for her residential placement at either care home 1 or care home 2. This is fault.
36. The Council says it gave financial information orally to Mr B and Mrs C. But the Council did not record this in its case notes, which is fault. Even if the Council did provide information orally, it is not reasonable to expect Mr B and Mrs C to remember what they were told as it was a stressful time. The Council should have provided information in writing and not doing so is fault.
37. Financial assessments do not have to take place before a person receives care. If they did, people would be waiting for care – pending the assessment. But the Council took six months to carry out a financial assessment. This is too long and is fault. The fault was compounded by the Council not having properly advised Mr B or Mrs C at the start of the process about contributing to the cost of care. As I set out in paragraph 29, when the Council finally calculated Mrs C’s contribution to the cost of her care, its calculations were wrong.
38. The Council also initially refused to pay Mrs C’s care home costs from the end of January to April 2018. Although the Council argued the hospital should have told it Mrs C was going to be discharged, it was only two days before care home 1 told the Council Mrs C had returned. At this point, the Council should have undertaken an assessment, arranged suitable care, and arranged funding for Mrs C. Instead, it took the Council six months to resolve the issue during which Mr B was liable for all of care home 1’s cost. This is fault.
39. The faults identified caused Mr B injustice. There was uncertainty about the amount Mrs C owed in care costs and the Council initially refusal to contribute to her care costs between January and April 2018, causing avoidable distress.

Agreed action

40. Within one month the Council will:
• Apologise to Mr B and pay him £300 for the distress and uncertainty caused by the Councils faults.
41. And, provide guidance to the Older Adults Community Assessment Team about:
• what to record in their case records;
• providing fees and charging information to families during the assessment process; and
• aiming to complete a full financial assessment within 28 working days.
42. The Council should provide the Ombudsman with evidence that the above recommendations have been completed.

Back to top

Final decision

43. I have completed my investigation and uphold Mr B’s complaint. Mr B has been caused an injustice by the actions of the Council. The Council has agreed to take action to remedy that injustice.

Back to top

Investigator's decision on behalf of the Ombudsman