Summary: Mrs B complains she was misinformed about charges for her father’s care. She also complains about the amount of care he received and that he was not provided with reablement service. The Ombudsman does not find fault with the Council.

The complaint

1. Mrs B complains she was misinformed about charges for her father’s, Mr C, care when he was discharged from hospital. She also complains the Council:
• failed to carry out a home assessment before discharging her father;
• failed to respond to her father sleeping on the sofa when he was discharged from hospital;
• assigned two care workers that were not needed; and
• failed to consider reablement care.

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The Ombudsman’s role and powers

2. 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)
3. 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)
4. We investigate complaints about councils and certain other bodies. We cannot investigate the actions of bodies such as the National Health Service (NHS). (Local Government Act 1974, sections 25 and 34A, as amended)

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How I considered this complaint

5. During my investigation I:
• spoke to Mrs B and considered the information she provided;
• made enquiries with the Council and considered its response; and
• reviewed relevant law, guidance and policy.
6. Mrs B and the Council had the opportunity to comment on my draft decision and I carefully considered the comments.

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What I found

Law, guidance and procedure

7. Councils can make charges for care and support services they provide or arrange. Charges may only cover the cost the council incurs. (Care Act 2014, section 14).
8. Councils must assess a person’s finances to decide what contribution he or she should make to a personal budget for care. The Council can take a person’s capital and savings into account subject to certain conditions. (Care Act 2014 Department for Health, ‘Fairer Charging Guidance’ 2013, and ‘Fairer Contributions Guidance’ 2010).
9. The Care Act 2014 gives local authorities a legal responsibility to provide a care and support plan. The care and support plan should consider what the person has, what they want to achieve, what they can do by themselves or with existing support and what care and support may be available in the local area. When preparing a care and support plan the local authority must involve any carer the adult has. The support plan may include a personal budget which is the money the council has worked out it will cost to arrange the necessary care and support for that person.
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)

What happened

11. The below chronology is a summary of relevant information, it does not contain everything I reviewed during my investigation.
12. Mr C was admitted to hospital in March 2019. The Council completed a social care assessment and produced a care and support plan. Mrs B was present for the assessment. It was agreed on discharge home Mr B would need two support workers to visit three times a day.
13. The Council says it told Mrs B Mr C was not suitable for reablement support. This is recorded in Mr C’s assessment:

‘Physio has advised that Mr C’s mobility and transfers have reached his baseline and he will require support with a long-term care package with assistance from two others'.

14. Mrs B signed a form to confirm the ‘charging for social care and support received in the community’ had been explained to her. The Council says it provided Mrs B with written information about charging and financial assessments.
15. The Council sourced care to start when Mr C was discharged from hospital in April 2019.
16. Two days after discharge Mrs B contacted the Council and asked for the care package to be reduced to two visits a day because the family could support Mr B during the day. A few days later Mrs B asked for a further reduction to one morning visit.
17. The Council made a referral to Occupational Therapy when Mrs B raised concerns about her father having difficulty when using the bathroom.
18. The Council carried out a review within two weeks of discharge, with Mrs B present. The case was transferred to the community team. It was agreed Mr C would continue to have support from two carers once a day. The Council confirmed Mr C would be required to pay because his savings were over the threshold.
19. In June 2019 Mrs B complained to the Council about being charged for Mr C’s care. In response it said:

‘In terms of what you refer to as “free care for six weeks”, my assumption is you might be referring to Warwickshire County Councils Reablement Service. If the ward felt Mr C met the criteria for the Reablement Service they would have referred your father direct to Reablement and not sent a referral to the Hospital Social Care Team for an assessment of needs’.

20. Mr C was re-admitted to hospital following a fall and referred to the reablement service. Reablement was declined:

‘Mr C requires ongoing care rather than Reablement. Family have been supporting with care. There are no clear goals for Mr C to participate with reablement’.

21. An assessment was carried out with Mrs B present. The care and support plan was updated and visits were increased to twice a day:

‘Rep (Mrs B) advised care package father will be receiving will be chargeable and he will receive a financial assessment. Information on financial assessments was passed to rep who appeared to understand what had been discussed with her. Rep signed the financial charging sheet on behalf or father.

22. Following a review Mr C was discharged from hospital to a residential care home, which was self-funded.
23. Mrs B complained to the Ombudsman in July 2019.
24. Mr C sadly passed away in October 2019.

My findings

25. I do not find fault with the way the Council informed Mrs B of the charges for Mr C’s care. Following Mr C’s first admission to hospital in March 2019 Mrs B was informed about the charging for care and financial assessments. This was also provided in writing. Mrs B signed a form to confirm this information had been explained to her. Mrs B was reminded of the charges again in June 2019 when Mr C was re-admitted.
26. Mrs B was present during the care assessments and reviews. She agreed with the care and support plan and I have found no evidence she raised concerns about the contents. The plan included details of the number of care workers and frequency of visits.
27. When Mrs B contacted the Council to request a reduction in the number of visits the Council acted on this.
28. I have found no evidence Mrs B told the Council her father was sleeping on the sofa when he returned home after being discharged from hospital.
29. I do not find fault with the way the Council made decisions about Mr C’s care and support or how it communicated with Mrs B about this.
30. There is evidence reablement support was considered but this was declined by the service. It is not my role to question the professional judgement of the decision maker when I did not find fault with the way the decision was made.
31. I found no evidence Mrs B was misinformed about care options for Mr C. The Council involved Mrs B in the assessments, reviews and decision making in relation to Mr C’s care and support.

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Final decision

32. I do not find fault with the way the Council informed Mrs B about charges for fathers care or the way it made decisions about his care.

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Parts of the complaint that I did not investigate

33. I did not investigate the following parts of Mrs B’s complaint:
• There was information and statements contained in hospital reports and letters that were inaccurate.
34. We are unable to investigate complaints about the NHS.

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Investigator's decision on behalf of the Ombudsman