Summary: Mrs B complains that, due to delay in assigning her case to a social worker, her mother Mrs C had to spend fourteen weeks in a care home, instead of the planned six weeks. The Council then wrongly sent her mother a bill for her care. This caused her mother considerable distress. The Ombudsman considers that the waiving of the six weeks’ charges which Mrs C was due to pay, equivalent to £666, represents a suitable remedy for the injustice to Mrs C. The Council has also agreed to the Ombudsman’s recommendation that it pay Mrs B £620 in respect of the distress that she experienced, her time and trouble and transport costs.

The complaint

1. Mrs B complains that due to delay in allocating a social worker, her mother, Mrs C, had to stay in a care home much longer than she should have. She says that, although she was very well treated, the prospect of not being able to return to her own home caused her mother great distress and ongoing concern about having to go back into the care home.
2. She complains that the Council wrongly sent her mother a bill for nearly £1,500 for her care when this should have been sent to her as she had a Legal Power of Attorney for Finances. Her mother was not expecting to receive such a bill and this caused her mother further distress.
3. Mrs B has explained that she incurred taxi costs of £20 a journey for her mother come to visit and stay at weekends. She says she also had to take time off work and incurred further costs in providing a mobile phone so that her mother could call her.
4. Although the Council has waived all the care home fees, she does not consider that this is an adequate remedy for the injustice caused to her and her mother.

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The Ombudsman’s role and powers

5. 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)
6. 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

7. I have considered Mrs B’s written complaint and supporting papers and spoken with her. I have made enquiries of the Council and considered its response. I have also sent Mrs B and the Council a draft decision and considered their comments.

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What I found

Legal and administrative background

Assessment

8. Sections 9 and 10 of the Care Act 2014 require local authorities to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to all people regardless of their finances or whether the local authority thinks an individual has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and, where suitable, their carer or any other person they might want involved.
9. The Council must carry out the assessment over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Local authorities should tell the individual when their assessment will take place and keep the person informed throughout the assessment.

Intermediate Care and Reablement

10. Intermediate care and reablement support services are for people 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 say local authorities must not charge for the first six weeks of intermediate care or reablement services. They may make a charge where services are provided beyond the first six weeks but should consider continuing providing them without charge because of the preventive benefits. (Reg 4, Care and Support (Preventing Needs for Care and Support) Regulations 2014)

Charging for temporary residential care

11. 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 must follow these rules when undertaking a financial assessment to determine how much a person must 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).

Council charging policy

12. The Council’s policy is set out in the policy document Charging and Financial Assessment for Adult Care and Support Services:

“3.2 Services we will charge for:

• Any Care and support provided to meet a person’s assessed needs unless specifically exempted by law or this Policy.
• Where an adult is able to meet the full cost of their care, the council will make a charge for putting in place arrangements to meet need, when requested to do so, however the council will only recover the actual costs incurred in accordance with section 18 of the Care Act.

3.3 Charges will be made after a full or light touch financial assessment has been undertaken to ensure the adult is not charged more than it is reasonably practicable for them to pay.

3.4 The amount charged for care and support in a non-residential setting will not reduce a person’s disposable income below Minimum Income Guarantee amount (MIG).

3.5 For residents or temporary residents provided with accommodation in a care home, a weekly personal expenses allowance (PEA), set annually by the Government is allowed when the charge for care and support is calculated.

3.6 Short term residents

Means a person who is provided with accommodation in a care home for a period not exceeding 8 weeks.

A standard charge will be made for a short term placement and the amount of the charge is detailed in the council’s Fees and Charges Booklet. The local authority has discretion to assess and charge as if the person were having needs met other than by the provision of accommodation in a care home i.e. at the same rate as if their needs were being met in the community.”

13. For short-term residential care (respite / assessment), the Council’s standard charge (then £111 per week) applies for up to the first eight weeks in a residential home. A request for a financial assessment can be requested after five weeks, and the full financially assessed charge payable from week nine.

What happened

14. Mrs C is in her late 70s and lives alone in her own home. She has several health problems. After suffering falls at home, Mrs C was admitted to hospital in early 2018. Prior to her falls, Mrs C was independent and would access the community on her own, with her daughter or a friend. Her daughter, Mrs B, lives around two miles away. While in hospital, Mrs C was diagnosed with vascular dementia.
15. Before her discharge from hospital, a hospital social worker undertook an initial assessment of Mrs C with Mrs B present. They initially discussed a package of care at home, with assistive technology. But, given Mrs C’s and her family’s concern at returning home following her falls, the social worker concluded that Mrs C needed a period of assessment in a care home. A care and support plan was prepared and the Council agreed funding for six weeks. Mrs C’s contribution was £111 per week out of a total weekly cost of £529 for the placement.
16. On 26 January, Mrs C was admitted to the care home. Shortly after, a planning meeting was held at which Mrs B expressed concerns about what would happen if her mother returned home. Mrs C’s case was transferred to the Council’s social care team on 8 February.
17. On 28 February, Mrs B contacted the Council to get an update on the allocation of a social worker. The Council’s notes record that Mrs B advised that her mother was frightened to go back home as she felt she would not be able to manage.
18. A duty social worker returned her call but could not get through. She spoke with Mrs B the next day. They discussed the options if Mrs C could not return home, such as sheltered accommodation or moving to a smaller home. They agreed that a retirement home application form would be forwarded to Mrs B. They discussed mental capacity issues. The social worker also explained that an assessed charge would be payable and forwarded a financial assessment form to Mrs B. The social worker explained that the case was still awaiting allocation.
19. On 8 March, Mrs B contacted the Council again to say that her mother was now in the final week of her planned six-week assessment stay but had not yet been contacted by anyone or assessed. This was causing her some distress.
20. On 14 March, the Council’s duty social worker received a call from the hospital Occupational Therapist (OT). The OT explained that she had received a referral from the Citizen’s Advice Bureau (CAB) and wanted to visit Mrs B. She wanted to know if a social worker had been allocated and how the decision had been taken to place Mrs C in her present care home. The duty social worker said she could not provide further details without Mrs C’s consent and suggested that the OT contact the CAB for further detail.
21. Mrs C’s case was allocated to a community social worker on 16 March. The social worker called Mrs B and left a message the same day. She called Mrs B again on 19 March to introduce herself and arrange to meet Mrs C.
22. A meeting was held on 21 March. The social worker noted that Mrs C was lucid, able to meet her care needs and wanted to go home. However, considering her previous falls and recent diagnosis, he wanted the hospital’s community OT to carry out an assessment before arranging her discharge. Mrs B agreed to pay the first six weeks’ charge but asked if she would have to pay the full charge thereafter as it was not her mother’s fault that she had to stay longer.
23. The next day, the social worker contacted the hospital’s community OT who advised that a community OT worker would contact Mrs C the week of 2 April. The social worker advised that he would be on holiday until 17 April but the OT could update the Council’s Social Care Duty Team in the meantime.
24. The OT carried out a home visit with Mrs C on 18 April. It was agreed that Mrs C could return home with some initial reablement support, a fall detector and pill dispenser. The social worker completed a referral on 23 April for a fall detector and pill dispenser (for which there was a charge) to allow Mrs C to return home.
25. Mrs C returned home on 1 May with a reablement service in place. A financial assessment form was sent to Mrs B the following day.
26. On 10 May the Council’s finance department was copied into an email in which the service manager confirmed that she had agreed to charge Mrs C only the standard respite / assessment charge for the whole stay. On 14 May, the finance department arranged an appointment to complete the forms. Mrs B later cancelled this as she was stressed with dealing with her mother’s situation.
27. After a review of Mrs C’s care needs, the reablement service was first reduced and then ended from 1 June. At the review meeting with Mrs C and her friend, the social worker explained the background to the delay in his involvement in the case. He explained that the Council had agreed that Mrs C should only have to pay the £111 respite charge for her whole stay. Mrs C and her friend felt that she should only have to pay for the first six weeks. The social worker agreed to send Mrs C a complaint form.
28. On 30 May, Mrs B called the finance department and explained that her mother did not want to provide her financial information, as she only had the fall service in place and was willing to pay the charge for this.
29. On 6 June, Mrs B emailed the Council to complain that the care home had sent a bill for the full 14 weeks. She was very unhappy at the lack of explanation or apology for the delay and explained the impact that this had had on her and her mother.
30. The Council responded to Mrs B’s complaint and explained the reasons for the delay in her mother being discharged from the care home. In an email to Mrs B on 21 June the Council said that, having regard to the timeline of events, it would agree to waive costs for four weeks and that only the respite charge would be payable for the remaining ten weeks.
31. Mrs B was unhappy with the Council’s response and contacted her MP, who in turn contacted the Council. The Council agreed to put Mrs B’s complaint through its formal procedures and spoke to Mrs B to prepare a statement of the complaint. However, Mrs B said she was awaiting confirmation of the bill from the care home and understood that her mother was entitled to six weeks free care. She wanted to put the complaint process on hold until she had all the information she needed to pursue her complaint.
32. On 15 August, the care home contacted the Council. It had received payment from the Council but explained that Mrs B had said she would not pay the bill for the first six weeks as she was disputing this with the Council. The care home was advised to speak with Mrs B.
33. Mrs B contacted the Council again in early September to say that she was still awaiting comments from the care home.
34. On 24 October, the Council sent Mrs C a bill for £1499.57 for the full 14-week stay at the care home.
35. Mrs B contacted the Council and then set out her complaint in full.
36. The Council responded to Mrs B’s complaint on 21 November. It apologised for the delay in progressing her mother’s case and explained the background to the delay. It also apologised for sending the bill to her mother when this should have been sent to her as she had a Legal Power of Attorney for Finances. It explained that there would normally be a charge for up to six weeks but agreed to waive the charges for the full 14 weeks. It also provided a letter to confirm to Mrs C that there were no charges owing.
37. Since then, the Council has taken steps to change the remits of individual teams to address allocation delays by looking at the likely needs of service users and deciding which teams are best placed to deal with individual cases. This has resulted in most cases being allocated within 48 hours.
38. This, together with the recruitment of agency staff, had reduced the backlog of cases from over 500 to under 200 by September 2019 with the backlog expected to have been cleared by the end of October.

My assessment

39. These events have caused Mrs C and her daughter considerable distress. I note that the Council has accepted that there was fault on its part and has sought to remedy this by apologising and waiving the full charge for Mrs C’s stay in the care home. I have therefore gone on to consider whether the remedy offered is appropriate, having regard to the Ombudsman’s Guidance on Remedies: Good Practice.
40. In order to consider what remedy has already been provided, I have considered what charges would have applied had there been no fault.
41. The Council had agreed 6 weeks’ stay at the care home to assess Mrs C’s needs and whether she would be able to return home. The documentation clearly sets out that the short-term stay was for the purpose of assessment, rather than intermediate care / reablement.
42. Mrs C was therefore not entitled to six weeks free care while staying at the care home, as the purpose of the stay was not intermediate care / reablement. I note however that free reablement support was subsequently provided when she returned home.
43. The Council was therefore entitled to charge Mrs C for six weeks’ stay at the care home based on its short-term respite / assessment rate of £111 per week. As a homeowner she would have been over the financial threshold and so required to pay the Council’s short-term care rate. By waiving this charge, I consider this to be equivalent to a payment to Mrs C of £666.

Delay

44. Mrs C was due to be in her care home placement for assessment for six weeks.
45. The Council accepts that there was delay in allocating a social worker and that this contributed towards the delay in discharging Mrs C from the care home. However, it suggests that part of the delay was due to a four-week wait in assessment by the Community OT, and that there was no reason why the Community OT visit to Mrs C could not gone ahead earlier without needing to wait for the case to be allocated to a social worker.
46. I agree that it took time for the OT assessment to take place and that it was also later than agreed by the OT. But even allowing for this delay in the OT assessment, it does not appear that Mrs C’s return home would have been substantially delayed beyond the agreed six weeks had the case been allocated promptly to a social worker.
47. I do not therefore consider that Mrs C should have been charged for the last eight weeks, and so I do not consider that waiving charge for the last eight weeks should be regarded as a part of any financial remedy towards Mrs C.

Bill

48. The Council agreed in its complaint response to Mrs B that the bill should not have been sent to Mrs C, because Mrs B had a Power of Attorney. It says its electronic case system allows for Powers of Attorney to be noted and correspondence adjusted accordingly. However, it has since explained that the letter was sent out automatically after the case was closed and it was therefore unaware that there was a Power of Attorney in favour of Mrs B.
49. It is unfortunate that the bill was sent to Mrs B and I appreciate that this caused her distress. However, I do not consider that I can criticise the Council for sending the bill out when it was due and while the complaint remained on hold.
50. However, I note that the bill that was sent was for the full 14 weeks and did not reflect the reduction to ten weeks that had been agreed and notified to Mrs B. This should have been recorded on the Council’s system and sending the bill for the wrong amount was fault.

Remedy for Mrs C

51. I have therefore considered whether waiving of the £666 payment for six weeks’ care is an appropriate remedy for the injustice caused to Mrs C.
52. Mrs C had to spend eight weeks longer than she should have in the care home. The care home was comfortable and she was well looked after, but she wanted to return home and suffered considerable anxiety and distress due to this delay. Mrs B says that the experience has badly affected her mother’s trust in the Council and continues to cause her anxiety at the prospect of returning to the care home. I do not consider that there was fault in the Council sending Mrs C the bill for her care, but it should have been made out for the correct amount.
53. When considering remedies for distress, the Ombudsman’s guidance says:

“A remedy payment for distress is often a moderate sum of between £100 and £300. In cases where the distress was severe or prolonged, up to £1,000 may be justified. Exceptionally, we may recommend more than this.”

54. The waiving of the care home fees is equivalent to a payment to Mrs C of £666. I have taken account of the distress that Mrs C experienced and am conscious of the impact that this has had on her. However, having regard to the Ombudsman’s guidance, I do not consider it appropriate to seek a financial remedy in excess of the £666 which Mrs C has already received through the waiving of the first six weeks’ charges.

Transport and other costs incurred by / injustice to Mrs B

55. I have also considered whether any remedy would be appropriate for the injustice caused to Mrs B.
56. Transport - Mrs B has explained that she arranged for her mother come over to visit or stay every weekend. This meant paying £20 for a taxi both ways because her mother could not travel by bus, and she could not take the bus as it was difficult for her to walk to the bus stop due to the distance and her severe arthritis.
57. The Council says that Mrs B did not raise any concerns about transport costs during her mother’s stay, and that it might have provided transport had this been requested. I appreciate that this may be the case but, given that Mrs C was paying towards her care, I see no reason why Mrs B should have assumed that the Council would provide free transport for Mrs C to visit her.
58. It seems to me reasonable therefore to assume that Mrs B had to pay for her mother to visit on eight weekends when she should already have been discharged from the care home.
59. I have also considered whether it was necessary for Mrs B also to use the taxi on the round trip. The Council says there is little difference between the journey time between Mrs B’s home and her mother’s home, and that to the care home. Having checked the bus routes, there appears to be a much longer walk to the bus stop when traveling to the care home than when using the route to her mother’s home. Given Mrs B’s arthritis, I see no reason to question her statement that she needed to take a taxi in both directions. I consider that the Council should therefore pay Mrs B £320, representing the cost of 16 round trip journeys.
60. Time off work - Mrs B has also mentioned that she has had to take time off work for meetings.
61. The Council has explained that Mrs B attended three meetings in respect of her mother’s care. These comprised the initial assessment at the hospital, which was at a date and time agreed with Mrs B, a planning meeting at the care home and a social work assessment at the care home.
62. I see no reason to seek any payment in respect of these meetings. It is to be expected that it will be necessary to attend some meetings to discuss a relative’s care, and there is no indication that Mrs B had to attend an excessive number of meetings.
63. Mobile phone - Mrs B says she incurred substantial costs in providing a mobile phone for her mother to call.
64. I appreciate that Mrs B may have incurred costs in this regard, but the mobile phone will continue to be of benefit to her mother. Moreover, it is possible to arrange cheap monthly contracts so there is no reason for this to have been a significant expense. I see not therefore see grounds to seek a remedy for this.
65. Distress / time and trouble – Aside from the distress experienced by her mother, it has also upset Mrs B to see how her mother has been affected by these events. Mrs B has also had to spend time trying to resolve the situation with her mother’s care and getting the Council to waive the charges which should not have been incurred.
66. Having regard to the Ombudsman’s guidance, I consider that a payment of £200 to Mrs B for distress and a payment of £100 for her time and trouble would be appropriate remedies.

Agreed action

67. The Council has agreed to the Ombudsman’s recommendation that it pay Mrs B £620 in recognition of the distress she experienced as a result of these events, her time and trouble, and the transport costs she incurred for her mother to visit.
68. The Council should arrange for this payment to be made within one month of the decision date on this complaint.

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Final decision

69. I have closed my investigation into Mrs B’s complaint as I consider that the agreed remedy resets a suitable response to the injustice caused to Mrs B.

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Investigator's decision on behalf of the Ombudsman