Summary: Mrs X complains the Council failed to properly explain its charging policy and charged her late mother, Mrs Y, for respite and nursing home fees when she believed it would be free. There was no fault in the Council’s decision to charge Mrs Y for respite and nursing home fees. There were faults in the way it invoiced Mrs Y and Mrs X and in the way it responded to Mrs X’s complaint. The Council has agreed to apologise to Mrs X, pay her £200 for the distress and frustration caused by the faults and write to her clearly setting out what is owed for what time period. It has also agreed to review its procedures to ensure care services are ended properly on its systems.

The complaint

1. Mrs X complains the Council failed to properly explain its charging policy and charged her late mother, Mrs Y, for respite and nursing home fees when she believed it would be free. Mrs X is now faced with a large and unexpected bill.

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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 the information provided by Mrs X and have spoken to her on the telephone. I have considered the Council’s response to my enquiries.
5. I gave Mrs X and the Council the opportunity to comment on a draft of this decision.

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What I found

6. The charging rules for residential care are set out in the “Care and Support (Charging and Assessment of Resources) Regulations 2014”, and the “Care and Support Statutory Guidance 2014”. When the Council arranges a care home placement, it has to follow these rules when undertaking a financial assessment to decide how much a person has to pay towards the costs of their residential care.
7. The rules state that people who have over the upper capital limit are expected to pay for the full cost of their residential care home fees. However, once their capital has reduced to less than the upper capital limit, they only have to pay an assessed contribution towards their fees.
8. The council must assess the means of people who have less than the upper capital limit, to decide how much they can contribute towards the cost of the care home fees.
9. People in a care home will contribute most of their income towards the cost of their care and support. However, the council must leave the person with a specified amount of their own income to spend on personal items (the personal expenses allowance).
10. A temporary resident is someone admitted to a care or nursing home where the agreed plan is for it to last for a limited period, such as respite care, or there is doubt that permanent admission is required. The Care and Support (Charging and Assessment of Resources) Regulations 2014 and the Care and Support Statutory Guidance 2014 set out charging rules for temporary residential care. When the Council arranges a temporary care home placement, it has to follow these rules when undertaking a financial assessment to determine how much a person has to pay towards the costs of this stay. The Council can either charge the person under the rules for temporary residential charging or treat the person as if they are still living in the community (i.e. the non-residential rules for charging).

What happened

Respite stay

11. Mrs Y lived with Mrs X and received two daily domiciliary care visits from a care agency. Mrs X contacted the Council to request a respite stay for Mrs Y to enable her and her family to go on holiday.
12. In June 2017 a Council officer visited Mrs Y to assess her for a respite placement. Mrs X was also present. Mrs X says the officer told her the respite stay would be free. The Council’s records noted Mrs Y ‘has already signed the charging letter and she understands that respite is a chargeable service. Red Charging booklet given [the Council’s booklet on charging for residential care]’. The charging letter set out that the Council would carry out a financial assessment to see how much Mrs Y would contribute to the care home fees. It stated ‘the amount you contribute will depend on your weekly income, how much you have in savings and whether you own a property or other assets’.
13. Mrs Y had a respite stay at a care home for two weeks at the end of June 2017.
14. In July 2017 a Council officer telephoned Mrs X to carry out a financial assessment for the respite stay. The Council officer noted Mrs X was not happy as she said she was told the respite would be free. Following the assessment, the Council wrote to Mrs Y. It noted that as she owned an unoccupied mobile home it would charge her the full cost of the stay at the care home. The letter stated the cost was around £750 per week for the stay.
15. Mrs X contacted the Council about the charges for the respite stay. The Council looked into Mrs X’s concerns. It had incorrectly treated her as owning a property rather than treating the mobile home as capital. It reassessed Mrs Y’s contribution to her respite charges. It wrote to confirm her charge was now £184.35 per week. It did not place an end date on the respite stay so Mrs Y continued to be billed for it after the placement ended.
16. Mrs X contacted the Council about the respite charges as a direct debit for £3000 was taken from Mrs Y’s bank account. The Council responded and apologised and noted a credit was due on the care account.
17. A council officer called Mrs X in August 2017 about the respite charges. They noted Mrs X said she had received two invoices for respite care, one for £3000 and one for £300. The officer told Mrs X the Council had wrongly charged Mrs Y the full cost of respite. It had reassessed Mrs Y’s care charges and sent a new charging letter. Mrs X said she had not seen this. The officer confirmed services were not free and respite was chargeable. They agreed to re-send the revised charging letter to Mrs X.
18. A finance officer noted there was no end date on the system for Mrs Y’s respite stay. It added this and the revised charge for the stay was £421.37. It issued a revised invoice in August 2017.
19. Mrs X complained to the Council in August 2017 about the direct debit of over £3000 taken from Mrs Y’s account for respite care. She also complained she was advised respite was not chargeable and she had continued to receive incorrect invoices.
20. The Council wrote in response Mrs X’s complaint in November 2017. The letter set out that:
• The case officer had explained respite was chargeable and Mrs Y had signed the charging letter;
• Mrs Y was initially assessed as able to pay the full cost and as the Council placed no end date on the system Mrs Y as overcharged;
• It had reassessed Mrs Y and wrote to Mrs Y in July 2017 to advise her of this and applied a credit to the account;
• Mrs Y’s direct debit details were on the system because she had previously paid for domiciliary care in this way;
• The Council understood Mrs X had reclaimed the £3000 using the direct debit indemnity and it had removed the direct debit details from its system.
21. The Council partially upheld the complaint. The Council incorrectly addressed the complaint response so Mrs X did not receive it.

Full time residential care

22. Mrs Y continued to live with her daughter, receiving domiciliary care visits from a care agency. Mrs X contacted the Council in January 2018 as Mrs Y’s health and condition was deteriorating. A council officer visited later that month and assessed Mrs Y as requiring nursing care. The Council’s notes record that at the visit the officer explained the charging policy, provided a copy of the charging for residential care booklet and Mrs X signed the charging letter.
23. In February 2018 Mrs X identified a care home for Mrs Y. Mrs Y moved into the nursing home mid-February 2018. The Council carried out a financial assessment in March 2018.
24. The Council wrote to Mrs Y at the care home in mid-April 2018. The letter set out the financial contribution of £272.45 she was expected to pay towards her nursing home fees. It also apologised for the delay in applying the charges.
25. In late April 2018 the Council sent Mrs X an invoice for Mrs Y’s residential care charges. The invoice also referred to non-residential care charges.
26. Mrs Y died in late April 2018. The Council reviewed Mrs Y’s account and noted it had continued to charge Mrs Y for her domiciliary care package up to April 2018 even though she was in residential care. It amended its records.
27. Mrs X emailed the Council in June 2018. She said she was receiving incorrect invoices and was being charged for Mrs Y’s nursing home which she said was not explained to her nor did she sign anything to agree to this. The Council sent Mrs X an account statement. Mrs X responded that she did not understand it and complained to the Council. She complained she had not received a response to her complaint about paying for respite care, raised issues about the quality of care and complained she was not told she would have to pay for the nursing home.
28. The Council re-sent the complaint response from November 2017 to Mrs X. It responded to the other issues she raised in July 2018. It said the officer had explained the financial procedures in place for residential and nursing care when they visited in January 2018. The letter set out the amounts Mrs Y was assessed to pay based on her weekly income from her pension and pension credit.
29. In June 2019 the Council sent Mrs X an invoice for £3,861.47 which remains owing.

Findings

Respite Stay

30. The Council’s records show Mrs Y signed a charging letter and was provided with a booklet about charges for residential care when she agreed to a respite stay. I do not know exactly what was said when the Council officer visited Mrs X and
    Mrs Y but the records support that the Council informed Mrs X and Mrs Y there was a charge for respite. Mrs Y received respite and was required to pay for it. The Council is not at a fault for charging her for the respite stay.
31. The Council was at fault for initially incorrectly assessing Mrs Y as a full charge payer and for failing to end the respite stay on its finance systems. This meant Mrs X received inflated invoices for the respite stay, causing confusion and distress. The Council was also at fault for taking a direct debit from Mrs Y’s account. However, Mrs X used the direct debit indemnity to reclaim this money so it did not cause a significant injustice.
32. Mrs X complained about the respite charges in August 2017 and the Council did not respond until November 2017. This delay is fault. In addition, Mrs X never received the letter as the Council addressed it incorrectly.

Residential care

33. The Council has a legal duty to charge for residential care. When Mrs X moved full time into a nursing home, Mrs Y was expected to contribute her income towards this charge minus a small amount for her personal allowance. Mrs X says this was not explained however the records show she was given the Council’s charging for residential care booklet which clearly sets out how a financial contribution is calculated. The Council is not at fault for charging Mrs Y for her contribution towards her nursing home costs. Mrs Y received care and so was required to pay for it, in line with the regulations.
34. The Council took too long to carry out the financial assessment. We would normally expect this to be completed in around 28 days. Mrs X entered the nursing home in February 2018 and the Council did not complete this until mid-April 2018. This delay is fault.
35. The Council has explained how Mrs Y’s contribution was calculated and has charged Mrs Y in line with the regulations. It is not at fault for charging Mrs Y for the care she received. However, the Council continued to invoice Mrs X for Mrs Y’s domiciliary care charges during the time Mrs Y was in residential care. This is fault. The errors in invoicing have caused Mrs X confusion. The Council has invoiced Mrs X in June 2019 but the invoice just gives a total figure. The Council has not clearly shown what the charge is for. The account statement provided in June 2018 contained thirteen adjustments and did not clearly summarise what Mrs Y owed for what care provision.

Agreed action

36. To remedy the injustice identified above the Council has agreed to:
1. apologise to Mrs X and pay her £200 to acknowledge the confusion caused by its errors in calculating Mrs Y’s care charges;
2. write to Mrs X setting out exactly what charges remain outstanding, for what care provision and for what time period; and
3. review its procedures to ensure end dates for care services are accurately recorded on its finance system at the time care is ended.
37. It should carry out a) and b) within one month and c) within two months and provide the Ombudsman with evidence it has done this.

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Final decision

38. I have completed my investigation. There was fault leading to injustice, which eth Council has agreed to remedy.

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Investigator's decision on behalf of the Ombudsman