Summary: The Ombudsman has not found fault in the way the Council communicated with Mrs C about the charges for her mother’s care. It has not upheld the complaint about incidents involving two of the care agencies.

The complaint

1. Mrs C complains on behalf of her mother, Mrs D. She says the Council failed to provide her enough notice or information about the contribution Mrs D had to pay towards the cost of her care. She says the contribution is too high and Mrs D should not have to pay any contribution as the quality of care was poor.

Back to top

The Ombudsman’s role and powers

2. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word ‘fault’ to refer to these. 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)
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)

Back to top

How I considered this complaint

4. I have discussed the complaint with Mrs C. I have considered the documents that she and the Council have sent and both sides’ comments on the draft decision.

Back to top

What I found

Law and guidance

5. The Care Act 2014, the Care and Support Statutory Guidance 2014 (updated 2017) and the Care and Support (Charging and Assessment of Resources) Regulations 2014 set out the Council’s duties towards adults who require care and support and its powers to charge. The Council also has its own policies.
6. The Council has a duty to assess adults who have a need for care and support. If the needs assessment identifies eligible needs, the Council will provide a support plan which outlines what services are required to meet the needs and a personal budget which explains the cost of the services.
7. Councils must carry out a financial assessment to decide what contribution a person should make to a personal budget for care. Councils must have regard to the detailed guidance on the treatment of income and capital.
8. In terms of capital, the upper capital limit is £23,250 and the lower capital limit is £14,250. If a person’s capital is lower than £14,250 they will not be expected to contribute from their capital, but may still need to make a contribution from their income.
9. The guidance says that, if a person is receiving care at home, the charges should not reduce a person’s income below the minimum income guarantee (MIG). This reflects the fact that a person who receives care and support outside of a care home still has to pay their daily living costs such are rent, food and utilities. The council should also deduct housing costs (mortgage and council tax).
10. If a person incurs expenses directly related to any disability he or she has (disability related expenditure), the council should take that into account when assessing their finances.
11. Councils have some discretion in charging for people who receive care at home and should set this out in their policies.
12. If a person refuses a financial assessment or the council is unable to carry out a financial assessment because of the adult’s refusal to cooperate with the assessment, then the local authority is treated as having carried out the financial assessment.

What happened

13. Mrs D is an 89 year old woman who started to receive a package of care at home in May 2017. Mrs C complained about the Council’s charges for the care and the care companies that provided the care. I have summarised the events under those two headings.

Charging

14. This is a summary of the Council’s interactions with Mrs C about the financial assessment and the charges for the care package:
• 16 May 17: Council sent a financial assessment form to Mrs C asking her to return the information within 14 days. The letter was addressed to the wrong door number.
• 2 and 13 June 2017: Council sent reminder letters, but still to the wrong door number.
• 28 June 2017. Mrs C contacted the Council as she had not received the financial assessment forms. It transpired the forms were sent to the wrong door number. The Council sent the financial assessment forms to Mrs C by email.
• 3 August 2017: Council sent a letter to Mrs C chasing her for the financial information.
• 7 August 2017: Mrs C called the Council and said she was having difficulty obtaining the mortgage statements for Mrs D’s house.
• 24 August 2017: Council wrote to Mrs C chasing her for the documents (bank statements, mortgage statements) which she had still not sent.
• 22 September 2017: Mrs C told the Council she had posted the information.
• 25 September 2017 and 6 October 2017: Council wrote to Mrs C asking for further information.
• 11 October 2017: Mrs C rang the Council as she was very upset. She said the financial officer’s attitude was not good and she did not want to liaise with him in the future. She said she was not going to provide the financial information the Council wanted as some of her own money was mixed in the accounts as well. The Council officer informed Mrs C that, if she did not provide the information, the Council would charge Mrs D at full cost.
• 23 October 2017: The Council wrote to Mrs C and said it had been unable to carry out a financial assessment because she had still not sent the required information. Therefore, the Council would charge the full amount of the cost which was £403 per week. It said this charge started on 15 May 2017 and included a document which showed how the charge had been calculated. It said she could appeal the decision within 4 weeks. Mrs C says she did not receive this letter.
• 30 October 2017. The Council wrote to Mrs C asking for further information.
• 3 November 2017. Mrs C rang the Council. The officer said Mrs C was shouting and aggressive. Mrs C said the Council had no right to see Mrs D’s bank statements as it did not need to know what Mrs D spent her money on. She said she was ‘sick and tired of dealing with our rubbish’ and wanted the Council to deal with Mrs D directly from now on.
• 10 November 2017. The Council contacted Mrs D directly and explained the financial assessment process to her.
• 13 November 2017. The Council wrote to Mrs D and explained why she had been charged the full cost of her care. It enclosed an information booklet about paying contributions. It set out what information was still needed to complete the financial assessment. Mrs C says Mrs D did not receive this letter.
• 15 December 2017. The Council sent an invoice to Mrs C for £9,114.
• In the following weeks, Mrs C sent the financial documents to the Council and the Council carried out a financial assessment of Mrs D. It calculated that her weekly contribution was £111.
• 9 January 2018. The Council wrote to Mrs C and confirmed the new contribution figure to her. This had been backdated to May 2017. It sent her a copy of the financial assessment and a revised invoice of £3,094.
• 30 January 2018. The Council agreed a repayment plan which said Mrs D would pay an extra £50 per month to pay off the arrears. Mrs C says she involved the Citizens Advice Bureau who negotiated the repayments on her behalf.
• February 2018. Mrs C said Mrs D’s house needed a new boiler and she gave quotes for this. The Council said this did not affect its calculation of the contribution.

Care package

15. The Council assessed Mrs D’s needs for care and support in May 2017 and prepared a care plan. It said Mrs D was very frail and needed assistance from two carers to help her in personal care, dressing, toileting needs, keeping the house clean, preparing meals, moving around the house.
16. In her comments on the draft decision, Mrs C said she disagreed with the Council’s assessment of Mrs D’s needs and the care plan. She was of the view that Mrs C needed less support than the Council recommended and that Mrs C was more mobile than the assessment suggested.
17. The Council revised Mrs D’s care plan and changed the agency seven times between May 2017 and May 2018 because of Mrs C’s dissatisfaction with the agencies. Some agencies were employed for only a couple of weeks.
18. I have focussed my investigation on agency K and agency L as Mrs C put in a complaint about these agencies which the Council investigated as a safeguarding enquiry.
19. Agency K started to provide care to Mrs D on 14 October 2017.
20. Mrs C complained to the Council about agency K on 5 February 2018. Mrs C said she had taken Mrs D to the podiatrist where it was discovered that Mrs’s legs had blisters and were hot and infected. She said this was caused by agency K’s poor care. The Council changed to a new agency, agency L, the following day and started a safeguarding enquiry.
21. The Council’s safeguarding enquiry documents showed the following.
• Mrs C reduced Mrs D’s care package from four calls a day to two calls in November 2017. The care agency raised concerns with the Council as it said that two visits a day were not sufficient to meet Mrs D’s needs. Mrs D could not attend to her toileting needs or move without assistance. She was therefore left sitting in a chair for 12 hours which made her medical condition (DVT and cellulitis) a lot worse.
• Agency K raised a number of safeguarding concerns about Mrs D’s living conditions. It identified Mrs D as the most vulnerable user it was providing care for.
• Mrs C said there were faeces on the washing machine door and the floor. Agency K said that, after the care package was reduced from four to two calls a day, Mrs D tried to do some of the care tasks herself. Mrs D would try to attend to her toileting resulting in spillages. Things were made worse by the fact that Mrs D had four cats in the house. The carers would often arrive in the morning and have to mop the floor because of the spillages.

Also before Christmas, the washing machine stopped working and needed to be repaired or replaced which caused further problems.

22. Mrs C made a complaint about agency L (the agency that replaced agency K) on 19 February 2019. She said £40 which was left out for ‘meals on wheels’ had gone missing.
23. The Council received statements from agency L’s carers and there was no evidence to substantiate a theft. The family had not gone to the police and it was not certain whether Mrs D wanted to pursue this complaint.
24. The Council said Mrs D had the mental capacity to make decisions and it was not clear whether she was unhappy with the care that she was receiving. The Council questioned whether Mrs D wanted Mrs C to make these complaints on her behalf so the Council had to speak Mrs D directly.
25. The Council planned to visit Mrs D on 5 March 2018 to discuss the complaint with her.
26. Mrs D was admitted to hospital on 1 March 2018 with a suspected stroke. Mrs C called the Council on 6 March 2018 as she had received another invoice and said Mrs D could not pay it. She said Mrs D should not have to pay for poor care.
27. Both safeguarding enquiries were closed on 22 March 2018. Mrs D was not receiving care from either agency K or agency L and no risks had been identified.

The complaint

28. Mrs C complained to the Council on 30 April 2018 and the Council responded on 23 May 2018.
29. Mrs C said:
• She had changed the care agency six times because of inadequate care. She provided examples but did not say when the incidents happened or which agency was involved.
• The care Mrs D received was poor so she should not have to pay.
• She received a bill of £9,500 a week before Christmas.
• She had never been told before that Mrs D would have to pay for care.
• She had been led to believe during the original assessment that Mrs D was not expected to contribute to her care because she did not have sufficient funds.
• The assessment said Mrs D had £3,000 in savings which was incorrect as she only had 1,000.
• She was told that all correspondence had to be sent to her and was in her name as she had a Lasting Power of Attorney (LPA). She was told she could only change this if she gave up her LPA.
• She was given another invoice of £5,500. Mrs D’s boiler was old and needed replacing and this would cost £4,000.
• She wanted to know how this bill was allowed to get so high and why nobody made her aware before.
30. The Council said:
• Mrs D had six different agencies so far. It offered Mrs C direct payments so she could choose agencies directly.
• The bills could be put in Mrs D’s name if Mrs C preferred this.
• It referred to its most recent financial assessment and the calculation of the contribution. Mrs D’s current weekly income was £405 and her contribution was £122.
• Mrs D’s capital was not relevant as it was below the threshold.
• The outstanding balance was £3,908.

Analysis

31. I find no fault in the way the Council has carried out its financial assessment and its communications with Mrs C.
32. The Council explained from the outset in May 2017 that there would be a financial assessment which would determine what Mrs D’s contribution would be to her care package costs. It is unfortunate that the Council sent the initial letter to the wrong address but this only delayed matters by a month.
33. Mrs C had the assessment form and knew what information to supply on 28 June 2017. The Council continued to chase her for the information that she needed to send. It sent four chasing letters between June and October 2017 and was in constant communication with Mrs C to ask for the information.
34. It sent a letter to Mrs C on 23 October 2017 to say that Mrs D’s contribution had been calculated as £403 per week and that this would be backdated to May 2017 when she started to receive the care. Therefore, Mrs C was aware of the costs from that date and knew that the debt was accruing. There was no fault in the Council’s approach. The Council had given Mrs C a lot of time to provide the information. However, If the Council is unable to carry out a financial assessment, then it can proceed on the assumption that the person can self-fund their care.
35. The Council sent an invoice in December 2017.
36. Mrs C then provided the information and the Council carried out a financial assessment based on the information provided which reduced the amount of contribution to £111. The calculation of the contribution was in line with the guidance and the Council’s policy. The Council allowed the correct minimum income guarantee which applied to Mrs D (£189) and deducted the costs of housing (the mortgage repayment and council tax).
37. The MIG is set by central government and is intended to allow a person sufficient income to cover the cost of living in the community. This should include costs of repair/renewal of boilers and so on.
38. The Council has correctly ignored Mrs C’s capital as this is below the threshold.
39. Mrs C has also complained about the care Mrs D received. Unfortunately, she did not specify dates or the names of the agencies in her complaint to the Council or the Ombudsman and therefore I am limited in what it can investigate.
40. I have considered the two complaints Mrs C made about agency K and agency L.
41. In terms of agency K, the issue is made more complex because the care package was reduced from four calls a day to two calls a day. The Council’s care plan said Mrs D needed four calls a day to meet her needs. Therefore, it may well be that the care provided by agency K did not meet Mrs D’s needs, but I cannot say whether this was because the care was poor or because it was impossible to provide the care in the time that agency K was allowed. On the evidence that I have been given, I cannot find evidence of fault.
42. In terms of agency L and the allegation that £40 went missing, the carers gave statements which said they had not seen any note or any money for meals on wheels. The Council closed the case as it was impossible to come to a conclusion. In the absence of any other evidence, I cannot say there was fault in the actions of agency L.

Back to top

Final decision

43. I have completed my investigation and have not found fault by the Council.

Back to top

Investigator's decision on behalf of the Ombudsman