Summary: Ms C complains about the process through which the Council informed her about charges in relation to her mother’s temporary residential care. The Ombudsman found fault with regards to the Council’s actions. The Council’s offer to wave Mrs M’s temporary care home fees and pay a financial remedy for any distress, is a sufficient remedy for any injustice Mrs M and her family suffered.

The complaint

1. The complainant, whom I shall call Ms C, has made a complaint to us on behalf of her mother, whom I shall call Mrs M. Ms C complains the Council failed to provide timely and comprehensive information about the cost of Mrs M’s care and how this would have to be paid for. Ms C says there was also an unreasonable delay by the Council in carrying out her mother’s financial assessment. As such, it took almost eight months before the Council told them that her mother would have to pay for the entire cost in relation to her temporary residential care.

Back to top

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)

Back to top

How I considered this complaint

4. I considered the information I received from Ms C and the Council. I shared a copy of my draft decision statement with Ms C and the Council and considered any comments I received, before I reached my final decision.

Back to top

What I found

Legislative background

5. The Care and Support Act Guidance says that:
• Financial information and advice are fundamental to enable people to make well-informed choices about how they pay for their care. It is integral to a person’s consideration of how best to meet care and support needs, immediately or in the future.
• A council should be clear and transparent, so people know what they will be charged. The Council should provide enough information and advice, at the right time, to ensure that a client is able to understand any contributions they may, or will be, asked to make so they can make an informed decision.
• A council should normally complete a financial assessment once it has decided a person’s needs are eligible for council support or involvement, and before creating a personal budget and care and support plan.
6. The Care Act 2014 and its Statutory Guidance say that a Council should complete a financial assessment before arranging care services. It also indicates that, in cases when this is not possible, for instance in an emergency, a council should give the client a reasonable estimate of likely charges before they have to decide what support they want the Council to arrange. Furthermore, the Council is still required to complete the formal financial assessment as quickly as possible after that.
7. It also says that a care provider should only collect a third party top up payment, if the Council has agreed this with the person first. If not, the person has to pay the ‘top-up’ amount to the council. The council then pays the full amount to the provider. Furthermore, the care provider should not get involved with collecting a client’s assessed contribution to their care. This amount should be paid directly to the Council, when the Council has commissioned / contracted the care.

What happened

8. Mr M, who was Mrs M’s carer, went into hospital in early November 2018 after a fall. The neighbour contacted the Council to say that Mrs M would need urgent / emergency respite, because she would be unable to manage at home without Mr M. The Council placed Mrs M into temporary residential care the following day.
9. The Council has said it unsuccessfully tried to contact Ms C’s brother to discuss the situation and how the placement should be paid for. However, the Council has since acknowledged it failed to do this. Instead, it discussed this with the neighbour and relied on him to pass the information onto the family. The Council accepts it should not have tried to pass on important financial information via a neighbour. However, it says this was partially due to the emergency nature of the placement with the priority being to ensure Mrs M was placed.
10. The Council says that the information it provided to the neighbour was that: the Council would provide assistance up to the cost of its usual dementia residential respite rate of £553.21/week. Mrs M would have to pay a minimum client contribution of £138.10/week. However, this could be more if a financial assessment would conclude she could contribute more. In addition to any client contribution, a top up of £270 would be required from a third party, because the care home was more expensive than the Council usually pays for such placements. While there is evidence that the Council discussed the situation with the neighbour, there is no evidence that the Council provided this level of detailed information to him.
11. A few days after Mrs M went into care, the Council made a referral for a financial assessment to be completed. The Council called Ms C’s brother at the end of November 2018 to try and obtain some financial information via him. However, he explained that his father, who was still in hospital, had this information.
12. The family received an invoice from the care home in December 2018. It said the Council had agreed to pay £415 a week, her mother’s contribution was £138 per week and the top up would be £216 per week.
13. Ms C told me that, at this stage, the Council had still not explained to the family in writing how her mother’s care would have to be paid for. The Council has said it is sorry it did not send out its 'standard finance letter setting out possible costs'. It says it has discussed this with the workers concerned, because it is important everyone has timely information they can refer to, especially in a crisis situation.
14. In February 2019, the Council contacted Ms C twice to carry out a financial assessment. However, Ms C says she could not participate in this at the time because her father was very ill and subsequently passed away at that time. The financial assessment eventually took place at the end of April 2019.
15. The family subsequently received a letter two months later, which said the family would receive an invoice for £12,957.65. The Council has explained that, because Mrs M’s capital was more than £23,250 on 7 November 2018, she had to pay the full cost of the care placement.
16. Following a needs assessment, the Council decided in June 2019 that Mrs M’s temporary placement at the care home should become permanent.
17. Ms C subsequently complained to the Council. However, before the complaint process had been completed, Ms C received a letter from the Council in August 2019, which said the attached invoice was 'seriously overdue' and requested immediate payment otherwise 'we will have to take further action to recover this money'.
18. In response to Ms C’s complaint, the Council acknowledged to her that it should have provided information to the family at an earlier date and, in recognition of this, it offered a £500 goodwill payment.
19. In response to my enquiries, the Council said that:
• After it reviewed the case at senior level, it concluded that practice, in this instance, fell far below what would usually be expected of its staff and it would follow up the issues raised with relevant staff. It also would like full reimburse the cost of Mrs M’s temporary residential care between 7 November 2018 and 11 June 2019
• It will also apologise to the family that it failed to offer a more suitable remedy at an earlier point in the complaint process, and will pay the sum of £500 offered before.
• It will update relevant guidance and training within the Finance and Benefits Assessment Team, to ensure that referrals for financial assessments are actioned quickly, and that appropriate information is sent and action taken when an assessment is put on hold or takes longer to complete.
• Additionally, the Adult Social Care Complaints and Feedback Team will have a focussed and dedicated team workshop on ‘Ensuring a resolution focus to complaints handling’.
• The care home should not have chased asked Mrs M and her family for payments. The Council will review the relevant elements of its policy guidance (and put in place workforce associated training) to ensure it is clear, offers choice to clients (and third parties) and is compliant with the Care Act 2014. The Council anticipates to complete this by the end of November 2020.

Analysis

20. The Council has acknowledged it should not have tried to provide information via the neighbour. It also acknowledged it failed to provide timely and appropriate information to the family (particularly in writing), about the way in which Mrs M’s temporary placement would be funded. This added to the distress of the family at the time.
21. Furthermore, it agreed the care home should not have contacted Mrs M to try and obtain payments with regards to her temporary stay at the home.
22. I am satisfied with the remedy the Council has proposed to carry out.

Recommended action

23. I recommended that, within four weeks of my decision, the Council should:
• Provide a written apology to Mrs M and Ms C for the distress they have experienced.
• Pay the financial remedy offered by the Council, which is to reimburse the fees of the temporary care home stay to Mrs M and pay the £500.
24. Within twelve weeks, the Council should provide a report that highlights the specific changes it has made following the review, which the Council referred to above.
25. The Council has told me it has accepted my recommendations.

Back to top

Final decision

26. For reasons explained above, I upheld the complaint. I am satisfied with the actions the Council will carry out to remedy this and have therefore decided to complete my investigation and close the case

Back to top

Investigator's decision on behalf of the Ombudsman