Summary: Mrs Y complained the Council carried out a flawed financial assessment of her son which failed to take account of his relevant disability related expenditure. She also complained it sent invoices to the wrong address delaying her ability to appeal. The Council was not at fault.

The complaint

1. Mrs Y complains the Council carried out a flawed financial assessment of her son, Mr X, in December 2018 which failed to take account of his relevant disability related expenditure. This caused him anxiety and distress. She also complains it sent invoices to the wrong address which delayed her ability to appeal the assessment, causing her inconvenience and distress.

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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 information provided by Mrs Y, in writing and on the telephone. I have considered the Council's response to my enquiries.
5. I gave Mrs Y and the Council the opportunity to comment on a draft of this decision. I considered the comments I received in reaching a final decision.

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What I found

6. The Care and Support Statutory Guidance sets out that where a local authority arranges care and support to meet a person’s needs, it may charge the adult, except where the local authority is required to arrange care and support free of charge. Where it decides to charge, it must follow the Care and Support (Charging and Assessment of Resources) Regulations 2014 and have regard to the guidance. The overarching principle is that people should only pay what they can afford. Where a local authority has decided to charge, except where a light touch assessment is permissible, it must carry out a financial assessment of what the person can afford to pay and, once complete, it must give a written record of that assessment to the person.
7. Because a person who receives care and support outside a care home will need to pay their daily living costs such as rent, food and utilities, the charging rules must ensure they have enough money to meet these costs. After charging, a person must be left with the minimum income guarantee (MIG), as set out in the Care and Support (Charging and Assessment of Resources) Regulations 2014. In addition, where a person receives benefits to meet their disability needs that do not meet the eligibility criteria for local authority care and support, the charging arrangements should ensure that they keep enough money to cover the cost of meeting their disability related expenditure (DRE). There is no set list of what is DRE. The Care and Support Statutory Guidance provides examples but says ‘any reasonable additional costs directly related to a person’s disability should be included’.
8. The Council’s financial assessment procedure sets out that “the financial assessment officer will obtain information regarding the individual's income, savings, investments, expenses and expenditure, which may be verified with the Department of Works and Pensions. This information is then used to calculate how much the individual has to contribute towards the cost of the care provided to them. As part of the financial assessment the financial assessment officer will complete a benefit check to ensure that the individual is receiving their full entitlement to benefits”.
9. Under disability related expenditure the procedure says “if an individual is in receipt of disability benefits, and unless the individual states otherwise, a standard allowance of £10.00 per week will be made. If an individual wishes they can have a detailed evaluation of their DREs, instead of accepting the standard £10.00 per week allowance. This will require the provision of supporting documentation (such as receipts and invoices). The relevant expenses must be directly and solely attributable to the individual's disability or illness, and specifically to social care needs, as opposed to medical care needs. Where receipts and other supporting information are not available at the time of the financial assessment visit, a period of 28 days will be allowed for these to be provided”.

What happened

10. Mr X lives in supported living accommodation. He has autism and learning difficulties and receives some one-to-one support hours to meet his assessed needs. Mrs Y is Mr X’s court appointed deputy for financial affairs. Following a change in the support provided to Mr X, the Council telephoned him in late November 2018 to arrange a visit to carry out a financial assessment. It sent a letter to Mr X titled ‘financial reassessment for adult non-residential services’. The letter explained an officer would visit ‘to complete a financial reassessment. During the visit we will also carry out a benefit check to ensure you are receiving all the benefits you are entitled to’.
11. An officer visited Mr X in mid-December to carry out the assessment. Mr X’s father and Mrs Y were also present. The Council has not provided any notes of what happened at the actual assessment. Mrs Y says the officer requested information about Mr X’s incomings and outgoings and entered the figures onto a computer. This included £21 a week of disability related expenditure related to carer support costs. The officer printed out the assessment on a mobile printer, which concluded Mr X needed to pay around £90 a week towards his care costs. Mrs Y says this information caused Mr X distress as he did not believe he could afford to pay this.
12. Mrs Y emailed the Council in mid-February as she had not received any further correspondence. The Council replied to the email attaching a copy of the financial assessment. It explained that if she was unhappy with the charge she needed to send the Council a letter of appeal. Mrs Y said she was waiting for an actual invoice to arrive before she appealed but no invoice was received. The Council’s records show it telephoned Mrs Y and left a message.
13. The Council sent monthly invoices to Mrs Y for Mr X’s care contribution. The Council telephoned Mrs Y in late May 2019 and left a message asking for a call back as she had not paid the fees. In August 2019, the Council telephoned Mrs Y again and told her of the arrears. The notes record Mrs Y advised she had left the address the Council had for her three years ago. She provided her new address and said she was appealing the care contributions. The Council issued revised invoices to Mrs Y’s new address.
14. In late September 2019, Mrs Y wrote to the Council to appeal the assessment. She explained she had not contacted the Council sooner due to a family bereavement and because the invoices were sent to the wrong address. She said she would provide a breakdown of Mr X’s expenditure.
15. The Council responded to Mrs Y in late October 2019. It explained the officer visited to carry out an assessment as Mr X had not had one for several years. It confirmed part of the role was to complete a benefit review. It noted Mrs Y had not received the invoices which were sent to her previous address. It said Mrs X did not provide an updated address until August 2019 and it had not received any returned mail. It explained how the assessment was calculated and offered Mr X a reassessment. It explained it would need to see bank statements so it could look at Mr X’s expenses.
16. Mrs Y emailed the Council in late October 2019 and provided a detailed breakdown of Mr X’s income and expenditure. Using this information, the Council reassessed Mr Y’s disability related expenditure in December 2019. It wrote to Mrs Y, setting out Mr X’s revised contribution of around £26 a week which it backdated to December 2018, increasing to £29 a week from December 2019 (due to a benefit increase).
17. In January 2020, the Council sent Mrs Y revised invoices. Mrs Y wrote to the Council and asked to appeal the Council’s decision to backdate Mr X’s contribution to December 2018. She asked for the backdated charges to be cancelled due to the flawed first assessment and the delays in carrying out the reassessment that meant the revised charge was not agreed until December 2019.
18. The Council responded in February 2020. It explained it had carried out a reassessment following receipt of the information she provided. It said as Mr X’s appointee it had dealt solely with Mrs Y, posting out notification letters and dealing with an appeal of care charges. It apologised if Mr X had been upset by the process.
19. Mrs Y remained unhappy and complained to the Ombudsman.

Findings

20. Mrs Y says she thought the financial assessment visit was held under false pretences as she believed it was for a benefits review. The Council wrote to confirm the purpose of the visit. Mrs Y may have misunderstood what the visit was for, but the letter did set out it was for a financial reassessment. The letter explained the officer would carry out a benefit check at the visit. This was in line with the Council’s procedures, which state the Council officer will carry out a benefit check during financial assessments to ensure the individual is receiving what they are entitled to. The Council was not at fault.
21. Mrs Y complained about the conduct of the visit. She felt the assessment was rushed and did not fully explore Mr X’s finances. There are no notes of the visit and I was not there so cannot comment on how it was conducted. However, Mrs Y, as Mr X’s representative, and Mr X’s father were present at the financial assessment so were able to present Mr X’s views. The completed financial assessment showed the officer recorded Mr X’s income and outgoings and there is evidence some disability related expenditure was taken into account. The calculations in the financial assessment were completed in line with the requirements of the law, statutory guidance and the Council’s own policy. There was no fault in the Council’s actions.
22. At the assessment the officer confirmed Mr X’s care contribution. Mr X was distressed by this and Mrs Y considered it would not leave him enough to live on. I cannot know exactly what was explained about disability related expenditure at the assessment. However, the officer also explained Mrs Y could appeal the assessment, a right which Mrs Y later used.
23. The Council was unable to reassess Mr X’s financial contribution until December 2019. The delay in calculating the correct contributions is likely to have caused Mr X some distress but that delay was not due to Council fault.
24. When Mrs Y contacted the Council in February 2019, the Council explained how she could appeal. Mrs X says she was waiting for an actual invoice to arrive before she did so. The Council sent Mrs Y invoices, but these were to a previous address. The Council was unaware the address was incorrect, so this was not fault. It was Mrs Y’s responsibility to provide an up to date address to the Council and I have seen no evidence she did so earlier. The Council’s records show it received her correct address in August 2019 when it telephoned Mrs Y about the account arrears. It then reissued the invoices to the correct address.
25. When Mrs Y provided the Council with further information about Mr X’s disability related expenditure in September 2019, it reassessed his financial contribution. The Council agreed to backdate the reassessment to December 2018, reducing Mr X’s debt.
26. Mrs Y considers Mr X should not have to pay the backdated contribution. Mr X has received care and support and the Council is entitled to charge for it. The Council has properly assessed Mr X’s contribution and Mrs Y was aware from December 2018 that Mr X was likely to have to contribute towards his care costs. There is no basis on which the Council should cancel these charges.

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Final decision

27. I have completed my investigation as there is no evidence of fault by the Council.

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Investigator's decision on behalf of the Ombudsman