Summary: Mrs X complained the Council failed to explain to her that she would be charged for a short-term residential care home stay while her property was being deep cleaned. The Council was at fault as there is no evidence the Council explained the potential cost of the care or provided her with information about the cost before she returned home. The Council has agreed to waive the charges, to remind staff of the need to advise service users of the potential costs before they agree to receive care and support and to ensure this is noted in the case records.

The complaint

1. Mrs X complained the Council failed to explain to her that she would be charged for a short-term residential care home stay while her property was being deep cleaned. This has left her with a bill for £920.25 causing her anxiety and distress as she cannot afford to pay it. Mrs X says she would have not stayed at the care home has she known about the cost.

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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. When considering complaints, if there is a conflict of evidence, we make findings based on the balance of probabilities. This means that we will weigh up the available relevant evidence and base our findings on what we think was more likely to have happened.
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 have considered Mrs X’s complaint and the information provided by her representative, on the telephone and in writing, on her behalf.
6. I have considered the Council’s complaint response to Mrs X and its Adult Social Care running records. I have considered the Care Act 2014 and the Care and Support Statutory Guidance 2014.
7. I gave Mrs X’s representative and the Council the opportunity to comment on a draft of this decision and considered the comments I received before reaching my final decision.

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What I found

8. 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).
9. The Guidance says the approach to charging for care and support should be clear and transparent so people know what they will be charged.
10. Councils must assess a person’s finances to decide what contribution he or she should make to the cost of their care. (Care Act 2014, section 17)
11. 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 whether to continue to provide them without charge because of the preventive benefits. (Reg 4, Care and Support (Preventing Needs for Care and Support) Regulations 2014)

What happened

12. Mrs X was admitted to hospital in February 2019. At the time the Ambulance Service raised concerns about the condition of Mrs X’s property, which she rented from a housing association.
13. In March 2019, the hospital’s discharge coordinator contacted the Council as Mrs X was medically fit for discharge. They had spoken to Mrs X who was aware of the condition of her property but she wanted to go home. She was deemed to have capacity to make this decision and so the Council agreed Mrs X could go home without any input from Adult Social Care. Following further discussion with the discharge coordinator the notes record Mrs X agreed she would need support when she returned home.
14. A social worker and student social worker met with Mrs X on the ward to discuss what support she may need after her hospital discharge. They agreed a relative of Mrs X’s could start decluttering her property, an Occupational Therapist would visit to assess her home environment, ‘short-term reablement to complete a strengths based assessment’ and for support with social isolation and maintaining a habitable level of living relating to nutrition, shopping, hygiene and laundry.
15. Two days later the student social worker visited Mrs X in hospital again with an officer from the Council’s reablement team. The notes record Mrs X’s property was in a worse condition than her relative had expected. The notes record the hospital’s complex case manager ‘has offered a placement at health’s expense in a cohort bed for up to 4 weeks to facilitate a discharge until home conditions are sorted out and prevention/support services put in place’. A social worker noted ‘to further discuss this with [their manager] as whether [an NHS bed] or LA bed as after 4 week period there may be a financial implication to LA if the home is not sorted out in the 4 week time frame’.
16. The Occupational Therapist visited Mrs X’s property and considered it was uninhabitable. Mrs X would not be able to access the rooms with a zimmer frame. The student social worker noted they would refer Mrs X for an interim residential placement while the property was cleared and cleaned. The Council says they also referred Mrs X for a financial assessment. There is no reference to any discussion about the financial assessment or the cost of the care home placement in Mrs X’s records. The student social worker also spoke to the Housing Association who recommended a cleaning company for carrying out a deep clean and suggested the Council contact a charity regarding charitable funding for the deep clean. The student social worker noted the Housing Association was aware Mrs X did not have the funds to pay for a clean and would even struggle on a payment scheme.
17. In mid-March 2019, the charity agreed to fund the deep clean. Around the same time, Mrs X was discharged from hospital and moved into the care home, initially for two weeks.
18. On 21 March 2019 Mrs X visited her home with a representative from the charity (her representative on this complaint) to meet the cleaning company. The student social worker also attended and Mrs X agreed to a referral to the Council’s Health and Well-Being Coach (HAWC) to support her in recognising the importance of her health, wellbeing and safety and in meeting goals relating to maintaining her property. They noted Mrs X would continue to live in the care home while the deep clean was carried out.
19. A Council officer arranged to carry out a financial assessment with Mrs X on 22 March 2019.
20. The cleaning company started the deep clean on 25 March 2019.
21. Mrs X visited her property on 2 April 2019 with the student social worker to make decisions about what furniture to keep. On the same day the Council says it sent a letter to Mrs X’s property setting out her financial contribution.
22. The HAWC visited Mrs X at the care home the next day. The notes recorded Mrs X just wanted to get back home and she had signed an agreement with the Housing Association about maintaining her property. The HAWC was concerned about Mrs X’s ability to pay the rent and council tax and noted she already had rent arrears and discussed whether Mrs X could claim other benefits.
23. The student social worker arranged a multi-disciplinary meeting for mid-April 2019 to discuss Mrs X moving back home. Mrs X and two relatives attended the meeting along with the social worker, student social worker, the HAWC, an officer from the Council’s reablement team, the charity representative and an officer from the Housing Association. The social worker noted the deep clean had finished but Mrs X was awaiting a hospital bed to be delivered. The plan included:
• The Housing Association would regularly monitor the property’s condition.
• The charity representative agreed to support Mrs X with a benefits application.
• The HAWC agreed to organise a furniture voucher for Mrs X and to continue to support her with maintaining her property and accessing the community.
• Reablement visits would start twice a day when Mrs X went home.
• Mrs X’s relative would provide informal support with cleaning on a weekly basis.
24. The charity representative says they asked at the meeting about the funding of the care home and were told it was on the social worker’s desk to deal with. There is no mention in the meeting notes of any discussion about the care home costs or Mrs X having to contribute to these.
25. The hospital bed was delivered to Mrs X’s home on 2 May 2019 and Mrs X returned home that day. The HAWC visited Mrs X the next day and supported her in accessing the community and setting goals for maintaining her property.
26. The student social worker spoke to Mrs X on 3 May. The notes record Mrs X ‘has received a letter asking her to pay towards her stay at [the care home]. SW student informed [Mrs X] to ring them to organise a weekly/monthly plan to pay the costs’.
27. Mrs X’s representative contacted the Council in mid-June. They stated Mrs X was told her care on discharge would be met by the hospital. The following day the student social worker spoke to Mrs X’s representative and noted in the records ‘Mrs X was under the assumption that she did not have to pay however student sw did not say this. [Mrs X] was concerned about leaving hospital to go to [the care home] and student sw informed [Mrs X] not to worry and that she would refer to CFO [community finance officer] for assessment of income.’ They noted Mrs X was paying large rent and energy arrears and had limited money.
28. Mrs X’s representative complained to the Council that Mrs X was not advised about the cost of the care home stay. The representative had supported Mrs X with her finances for a number of years and considered Mrs X would not have stayed at the care home had she known what the cost would be.
29. The Council wrote to Mrs X in November 2019 with the outcome of the complaint. It said:

• A financial assessment was requested when Mrs X was in hospital, but it was not completed until Mrs X moved into the care home.
• the allegation that the student social worker had told Mrs X the care on discharge would be met by the hospital was not correct.
• The stay was longer than anticipated due to the extent of cleaning required, increasing the cost.
• The officer who carried out the financial assessment verbally explained the costs but did not give Mrs X the leaflet ‘Guide to Charging for Community Based Services’.
• There was a lack of case note recordings detailing discussions about finances.

30. The officer concluded that they were ‘confident that in the process of engaging with the Community Finance Officer the purpose of the assessment ie to calculate the personal contribution toward cost of placement, was communicated verbally. It is unfortunate that the Guide to Charging for Community Services was not provided at this time but I am satisfied that although the specific amount could not be confirmed until the letter of confirmation was sent out [Mrs X] was advised that contributions would be payable from the commencement of the placement’. They concluded they would not waive the costs. They recommended Mrs X be offered a payment arrangement and recommended staff training on providing the Guide to Charging.
31. Mrs X remained unhappy and her representative complained to the Ombudsman.

Findings

32. Councils can make charges for the care and support they provide. However, the Guidance says the approach to charging for care and support should be clear and transparent so people know what they will be charged.
33. There is no evidence in the records to show the Council advised Mrs X there would be a cost associated with the residential care home placement when she agreed to move there. This is fault.
34. The notes show when Mrs X was in hospital, she was advised the hospital had offered her a four-week placement to enable her to be discharged. Mrs X therefore had an expectation the care would be free. The lack of advice about the cost meant Mrs X was not able to make an informed choice about whether or not to stay in the care home. Although the Occupational Therapist considered Mrs X’s property was uninhabitable Mrs X had capacity and was able to decide to return there if she wanted to, regardless of the condition.
35. When Mrs X’s representative raised the question of cost at the multi-disciplinary meeting, she says she was told it was on the social worker’s desk to deal with. There is no reference to any discussion about the cost in the notes of the meeting. By the time of the meeting the Council had carried out a financial assessment and written to Mrs X’s home address, setting out her contribution. This was an opportunity to explain the charges to Mrs X. The Council failed to explain to Mrs X what the charges for her care were and this is fault.
36. The letter notifying Mrs X of her financial contribution to the care home cost was sent to her home address. This was Mrs X’s permanent address so sending the letter there was not fault. However, the Council was aware she was not at home and Mrs X did not become aware of the letter until the day she returned home. She had regular meetings with Council staff but there is no record in the notes of anyone, at any time, explaining the costs or her contribution to Mrs X before she returned home.
37. The Council’s complaint response recognised the lack of evidence that Mrs X was advised of the potential costs but concluded it was satisfied Mrs X was aware she would have to pay a contribution from the start of the placement. The conclusion is not supported by the evidence and is fault.
38. This meant Mrs X was unable to make a decision about moving home earlier. Although Mrs X may not have had a hospital bed, she had capacity to make her own decisions and it was open to her to choose to return home without this. Given Mrs X’s financial difficulties and that she had lived in the property for a number of years I am satisfied, on the balance of probabilities that had Mrs X been advised of the cost she would either not have gone to the care home at all or would have stayed for a significantly shorter period than she did.

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Agreed actions

39. Within one month of the final decision on this complaint, the Council has agreed to apologise to Mrs X for the distress and anxiety caused, cancel the invoice and write off the debt for Mrs X’s stay in the care home.
40. Within two months of the final decision the Council has agreed to:
• Provide evidence of the action it has taken to ensure the Council’s Guide to Charging for Community Services is provided to service users and
• Remind staff of the need to ensure service users are advised before care commences of the potential costs of their care and support and reference to this is noted in the Council’s case records.

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Final decision

41. I have completed my investigation. There was fault causing injustice, which the Council has agreed to remedy.

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Investigator's decision on behalf of the Ombudsman