Summary: There is evidence of fault in this complaint. The Council took too long to complete a financial assessment which led to Mr & Mrs X receiving a large bill. There is no evidence to suggest the Council told Mrs X the care would be free.

The complaint

1. Mr & Mrs X complain the Council charged them for domiciliary care when a council officer told them the care would be free. She also says the Council delayed in completing a financial assessment which resulted in her receiving a backdated bill.

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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. 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

4. I have:

• considered the complaint and discussed it with Mr & Mrs X’s representative
• considered the correspondence between Mr & Mrs X and the Council, including the Council’s response to the complaint
• made enquiries of the Council and considered the responses
• taken account of relevant legislation
• offered Mr & Mrs X, and the Council an opportunity to comment on a draft of this statement.

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What I found

Relevant legislation

5. The Care Act 2014 gives councils the power to charge for care and support services they provide or arrange. Charges may only cover the cost the council incurs. Where a council decides to charge it must do so in line with the Care and Support (Charging and Assessment of Resources) Regulations. It must assess how much the person can afford to pay by completing a financial assessment.
6. The Care and Support Statutory Guidance 2014 makes it clear that the approach to charging for care and support needs should be clear and transparent so people know what they will be charged.

What happened

7. Mr X lives at home with his wife, Mrs X. During a stay in hospital in April 2019 it became apparent Mr X would need care and support when he returned home. Prior to Mr X’s discharge from hospital officers from social services visited him on the ward. Mrs X was present. Officers discussed domiciliary care services. The records show Mr & Mrs X agreed to am and pm visits to assist Mr X with personal care and continence. Officers also discussed carer support for Mrs X. Mrs X agreed to a referral to a carers organisation providing a sitting service.
8. Mr & Mrs X say officers told them the care would be free because the couple had capital below the threshold for charging.
9. The records show an officer explained to Mr & Mrs X that Mr X was ready for discharge from hospital, a transitional bed in a residential care home was offered until domiciliary services could be arranged. The officer said the residential stay would be free of charge for two weeks and would become chargeable thereafter. The officer also explained that Mr X would be financially assessed for his contribution towards his care package.
10. There was no availability at Mr & Mrs X’s preferred residential care home. The Council agreed a temporary stay at a different care home. An officer visited the ward again on 18 April 2019 to inform Mr & Mrs X. She reiterated the stay would be free of charge for two weeks, but chargeable on day fifteen.
11. Mr X became unwell and the discharge plans were cancelled. Mr X was deemed medically fit for discharge in May 2019. The Council offered a placement in two different care homes, but Mr & Mrs X declined both offers.
12. The records show a council officer spoke to Mrs X on 16 May 2019. Mrs X asked the officer if a financial assessment would still be completed. The officer confirmed it would, but she was unable to say when the assessment would take place or what the outcome would be.
13. Mr X was discharged from hospital back to his own home with a domiciliary care package. Once home it was identified he needed two carers because of decreased mobility. The Council allocated two carers until an Occupational therapy (OT) assessment could be completed. After the OT assessment was completed, it was deemed one carer to be sufficient, except for one visit, when two carers were needed to support Mr X with showering.
14. A council officer visited Mr & Mrs X at home on 5 July 2019. Mr & Mrs X reported the care to be going well. Shortly after Mr X was admitted to hospital again. Prior to Mr X’s discharge from hospital social services again offered Mr X a temporary stay in residential care home, Mr X declined the offer and returned home. Domiciliary care services commenced again on 16 July 2019, two carers four times a day.
15. A council officer contacted Mr & Mrs X on 19 July 2019. Mr & Mrs X reported the care to be going well.
16. On 23 July 2019 it was deemed one carer was sufficient to manage Mr X’s care.
17. The Council completed a financial assessment in August 2019. It concluded Mr X had to contribute £160.73 per week for care received between 20 May 2019 & 15 July 2019, and £167.70 per week for care received from 16 July 2019 onwards. The Council wrote to Mr & Mrs X on 20 August 2019 to inform them of the charges.
18. Mrs X telephoned the Council on 27 August 2019. She expressed concern about the assessed contribution, and said it was too high. The officer told Mrs X the cost would reduce as the care package reduced. A council officer contacted Mrs X again on 29 August 2019 to inform her of the revised contribution, £129.27 per week. Mrs X told the officer she would discuss the matter with her family.
19. Mrs X contacted the Council again on 3 September 2019 to say she and Mr X could not afford the care. The Council reviewed the care package. It reduced the care from nine hours 20 minutes x 2 carers per week to 7 hours 45 minutes per week.
20. Mrs X telephoned the Council on 4 September 2019 to say she wanted to cancel the care because they could not afford the payments and they would manage with help from family and friends.
21. Mrs X says if the financial assessment been completed sooner she and Mr X would have known the cost and they would have declined the service because they could not afford it.
22. The Council says the delay in sending what should have been 4-weekly invoices, was caused by staffing and work pressures within the team.
23. The Council contacted Mr & Mrs X again on 9 October 2019 to discuss the risk to Mr X in cancelling the care. The records show Mr & Mrs X were aware of the risks and had the capacity to make the decision.
24. With the support of her representative, Mrs X complained to Council. She said a council officer had told her the care would be free. She also complained about the delay in being informed about the cost of the care, and the backdated charges.
25. The Council responded to Mrs X’s complaint saying there was no evidence that officers had said the care would be free, and that its records show officers had informed Mrs X on two occasions that a temporary residential stay would be free of charge for two weeks, but subsequent care would be chargeable, subject to a financial assessment.
26. Mr & Mrs X say they have an outstanding debt of approximately £2300 for unpaid care contributions.

Analysis

27. The Care and Support Statutory Guidance 2014 makes it clear that the approach to charging for care and support needs should be clear and transparent so people know what they will be charged.
28. I am satisfied the Council told Mr & Mrs X that domiciliary care would be chargeable. The records show officers told Mr & Mrs X that a temporary stay in a residential care home would be free of charge for the first fourteen days but was chargeable from day fifteen. Mrs X was informed twice in April 2019 and once in May 2019 that domiciliary care would be chargeable and subject to a financial assessment. Mrs X enquired about the financial assessment in May 2019, I cannot see she would have done so if she had been told the care was free. There is no fault by the Council here.
29. The Council has accepted there was a delay in carrying out the financial assessment.
30. I need to consider what would have happened if the delay had not occurred and what injustice arose from it. Government guidance states that a financial assessment needs to be carried out as soon as possible. However, it does not say that a council cannot charge a contribution for any period before it has told a person the outcome of an assessment. I therefore cannot say the Council should waive all the outstanding fees.
31. However, taking too long to complete a financial assessment denies people the information they need to make informed decisions. It is reasonable to expect the Council to complete a financial assessment within 20 working days of care commencing. This is not what happened in this case. Mr & Mrs X received a large unexpected bill three months after domiciliary services started. I consider that Mrs X’s action in cancelling the care shortly after receiving the bill suggests she may not have accepted the service or cancelled it sooner had she known the cost earlier.
32. I consider it fair and reasonable that Mr & Mrs X pay for the first 20 days of care.

Agreed action

33. The Council should within one month of the final decision:

• apologise to Mr & Mrs X for the faults identified above:
• waive all but 20 days of the outstanding care fees, and issue a revised bill to Mr & Mrs X
• take steps to ensure financial assessments are completed within a reasonable timeframe.

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Final decision

34. As set out above, there is evidence of fault by the Council leading to an injustice, for which I have recommended a remedy, and the Council has agreed.
35. It is on this basis; the complaint will be closed.

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Investigator's decision on behalf of the Ombudsman