Summary: Mr X complained the Council failed to tell him that his son would need to contribute to the cost of his day-care. He also complains about errors in the financial assessment and delays in sending invoices. He says the late receipt of a large bill for services caused worry and distress. The Council was at fault for not telling Mr X about the day care charges, errors in its financial assessment and a delay in invoicing him for those charges. It should pay him £500 for the injustice caused.

The complaint

1. Mr X complained the Council failed to tell him that his son would need to contribute to the cost of his day care. He also complained about errors in the financial assessment that meant the Council initially asked for a higher contribution than it should have done. He further complained there was year’s delay in sending invoices for the care contribution, which meant he was suddenly faced with a very large bill to pay. This caused worry and distress for the family.

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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. We cannot question whether a council’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), as amended)
4. 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

5. I spoke to Mr X and considered the information he provided.
6. I considered the information the Council provided in response to my enquiries, including its case notes that provide a daily record of actions relating to Mr S.
7. I considered relevant law and guidance, as set out below, and our guidance on remedies.
8. Mr X and the Council had an opportunity to comment on my draft decision and I considered their comments before making a final decision.

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What I found

9. Sections 9 and 10 of the Care Act 2014 require councils 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.
10. Where the adult has eligible needs, the council should prepare a care and support plan setting out how the person’s needs can be met.

Financial assessment

11. Councils can make charges for care and support services they provide or arrange. They must assess a person’s finances to decide what contribution they should make.
12. The charges for care provided other than in a care home should not reduce the person’s income below the level of Income Support plus 25%. If a person incurs expenses directly related to any disability they have, the council should take these into account when assessing their finances. (Care Act 2014 Department for Health, ‘Fairer Charging Guidance’ 2013, and ‘Fairer Contributions Guidance’ 2010)
13. Where a person received respite care, the council can assess the contribution for that care as though they live in a care home. On this basis, the charges should not reduce the person’s income below the personal expenses allowance (PEA). This leaves the person with a much lower income because most of their daily expenses are covered by the care home fees.

What happened

14. Mr X is a deputy for his son, Mr S, and manages his finances. Mr S has day care support on some days during the week and respite care one weekend each month.
15. Mr X says the Council told him Mr S would need to contribute towards the costs of respite care. However, it did not tell him Mr S should contribute towards the cost of the day care.
16. The Council wrote to Mr X in June 2017 to explain Mr S would need to contribute to the cost of respite care and set out how it had calculated that contribution. It also says it gave Mr X it’s leaflet “What you should expect to pay for care” in November 2016. In response to my enquiries, it confirmed it did not send Mr X a letter about contributing to the day care costs until May 2018.
17. I have seen the Council’s records for Mr S, which show a new officer working on the case in February 2018 noticed Mr S had not been contributing to the cost of the day care. The officer asked Mr X about these costs in early March. Mr X said he had paid all the invoices the Council had sent him.
18. The officer made further enquiries with the Council’s credit control team, following which the Council sent Mr X an invoice for the day care costs from April to November 2017, amounting to £2,896.
19. The officer met Mr X to discuss the costs in early April. She said Mr S should be contributing to the cost of day care and gave Mr X the Council’s leaflet about care costs. Mr X said he should not have to pay for charges the Council had not told him about. However, he would start paying the contribution from this point onwards. The officer suggested Mr X ask for a fresh financial assessment to check the assessed contribution was correct and gave him information about the Council’s complaints process.
20. Mr X complained and the Council responded in May 2018. It said:
• its records said it gave Mr X a leaflet about care charges in November 2016;
• it had not charged for day care services since 1 April 2017 because it was in discussions about the contract with the provider;
• there was an error in the financial assessment relating to its consideration of the Daily Living Allowance Mr S received;
• it would issued an amended invoice; and
• it apologised for the late invoicing and for any inconvenience or upset caused.
21. The Council cancelled the March 2018 invoice and issued a new invoice for £1,101.76 in May 2018. Mr X asked if he could pay by instalments and the Council agreed he could pay £50 per calendar month. The Council said £470.20 was outstanding in early August 2019.
22. In its reply to my enquiries the Council said the delay in issuing the invoice was due to staff shortages and resource issues within the team. It said it was considering whether other families were affected by similar delays but it has not provided any further information about this.

My findings

23. The Council says it gave Mr X its leaflet about care costs in November 2016. The records show an officer met him to discuss the support Mr S needed. It does not state he was given the care leaflet nor that the costs of care were discussed.
24. The Council did write to Mr X about the respite care in June 2017.
25. An officer met Mr X in April 2018, discussed the care costs and gave Mr X the Council’s leaflet.
26. The Council has confirmed it did not write to Mr X about the day care costs until May 2018 although it charged him for the period from 3 April 2017. This was fault.
27. Although it carried out a financial assessment in April 2017 for the day care, I have seen no evidence it shared this with Mr X or discussed it with him. On balance, I have decided it did not do so. This was further fault.
28. The Council accepts there was a delay in issuing an invoice for day care from April 2017. This was fault. This fault meant it sent a large bill in March 2018 covering a whole year, which caused Mr X worry and distress.
29. The Council also accepts there was an error in the financial assessment, which meant the amount of the contribution was too high. This meant the bill it sent was nearly £3,000 when it should have been £1,101.76 for the period. This was fault and added to the injustice caused to Mr X.
30. In considering an appropriate remedy for these faults I have taken account the fact the day care support was provided and should be paid for. However, Mr X was not aware of the costs involved and could not therefore make an informed choice about the level of care to accept. As he was not aware of the costs he was not able to budget appropriately in order to meet them. Although objecting in principle to paying for costs he was not told about, Mr X did offer to pay the outstanding bill by instalments and has made monthly payments of £50.
31. Although the Council responded to the complaint and apologised for the failings it identified, it did not consider any financial remedy for the injustice caused. I consider in the circumstances it should have done so but this is not sufficient to warrant a formal finding of fault.

Agreed action

32. The Council will, within one month of the date of the final decision:
• Apologise to Mr X for the frustration caused by its failure to tell him about the day care charges, the 12 months delay in sending an initial invoice for this, and the errors in the financial assessment in May 2018.
• Pay him £500 for the worry, distress and financial inconvenience caused by these faults and a further £150 for his time and trouble pursuing this complaint.

The Council may offset this payment against any sums still outstanding in relation to the initial invoice for day care costs dated 11 May 2018.

33. The Council will, within three months of the date of the final decision:
• Review its processes to ensure it explains the likely cost of care as soon as possible after it has assessed the need for it, that it carries out a financial assessment without delay, and that it sends invoices for the assessed contribution without delay. It should report to us on the action it has taken as a result of this review.
• Identify whether any other families have been affected by the delay in sending invoices in period 2017 to 2018, and consider making a payment to them to reflect any injustice caused by such delays. It should report to us on the families it has identified, the injustice caused to each family and the action it has taken to address the injustice caused.

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Final decision

34. I have completed my investigation. I have found fault leading to injustice. I have recommended action to remedy that injustice and prevent recurrence of the fault.

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Investigator's decision on behalf of the Ombudsman