Summary: Mr X complains that the Council delayed in requesting a financial assessment in respect of Mrs Y’s contribution towards the cost of her care. We have found the Council to be at fault. To remedy the injustice this has caused the Council has agreed to apologise, reduce the charges for care and review its practices.

The complaint

1. Mr X complains on behalf of his mother Mrs Y, that the Council delayed in carrying out a financial assessment which has resulted in care fees that Mrs Y was not aware of. Mr X says that if his mother had known how much the care package would cost, she could have made a decision about her care sooner.

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The Ombudsman’s role and powers

2. 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)
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 the documents provided by Mr X, made enquiries of the Council and considered the comments and documents it provided in response.
5. Mr X and the Council had the opportunity to comment on my draft decision. I considered the comments I received before I made a final decision.

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What I found

Assessment and provision of care and support

6. The Care Act 2014 provides the legal framework for the assessment and provision of care and support for adults assessed by councils as having eligible needs. The Act is supported by several statutory regulations and the Care and Support Statutory Guidance (the Guidance).
7. Councils have a duty to assess if a person has care and support needs, and if so, what they are.
8. If a person is assessed as having eligible needs, the Council must meet these needs. In some cases, the Council can charge the person for the cost of their care and support
9. Councils decide whether to charge a person by completing a financial assessment. The Care and Support (Charging and Assessment of Resources) Regulations 2014 and the Care and Support Statutory Guidance set out how councils must calculate the amount an individual should contribute to their care.

What happened

10. Mrs Y is 89 years old and has been diagnosed with vascular dementia. She lives with her husband and Mr X and her daughter in law (Mrs X).
11. On 18 March 2019 Mrs Y was admitted to hospital following a deterioration in her health. She was discharged from hospital with a home care support package, fully funded by the Clinical Commissioning Group (CCG).
12. On 16 December 2019 a specialist nurse assessor and social worker (SW1) from the Council carried out a review of Mrs Y’s care and support needs. Mr and Mrs X were also present. An improvement in Mrs Y’s health was noted and it was agreed CCG funding would stop and the responsibility for arranging Mrs Y’s health and support needs be transferred to the Council.
13. The Council’s records show that SW1 explained to Mr and Mrs X that care and support services provided by the Council were chargeable. Mr X signed an initial financial assessment form which stated:

“It has been explained to me by my social worker that:

• all Care & Support services provided by [the Council] are chargeable, and
• that the purpose of completing the financial assessment form is to determine the amount I will need to pay towards any Care and Support services provided to me
• I may need to provide further information about my income, savings and outgoings to the financial assessment team
• the financial assessment team will conduct a financial assessment and notify me in writing that I will be required to pay for Care and Support Services”

14. The Council arranged for a home care package to meet Mrs Y’s needs which commenced on 16 January 2020. A home visit was carried out by SW2 on 10 February 2020 and identified that Mrs Y had not completed a financial assessment. Mr and Mrs X said they had not received a financial assessment and were not told the care was chargeable. Mr X said he was advised the care would be free until Mrs Y has been assessed by an occupational therapist. Mr X also explained that his parents would refuse to disclose their financial information.
15. On 13 February 2020 the Council sent a financial assessment form to Mr X. It asked Mr X to complete the assessment by 6 March 2020. Mr X explained that Mrs Y had “severe dementia” and “extracting information of any kind is not easy and very stressful for her”. The Council advised Mr X that if the assessment was not completed and returned with supporting information Mrs Y would be liable to pay the full cost of care of her care package. This would be charged at £18.60 per hour. The Council said if Mrs Y had savings over £23,250, she would be considered a self-funder.
16. On 4 March 2020 Mr X contacted the Council and requested to end the care and support package with immediate effect. SW2 contacted Mr X on the same day and arranged to carry out a home visit with an interpreter on 9 March 2020. At the visit it was explained that if Mrs Y’s savings were below £23,250 then only a contribution to care would be required. Mr X said that the family had alternative arrangements in place for Mrs Y’s care. The Council terminated the care and support package with effect from 10 March 2020.
17. On 6 May 2020 the Council wrote to Mrs Y stating she had not completed the financial assessment nor provided any supporting documents. It said Mrs Y was therefore liable to pay the full cost of care she had received. The Council invoiced Mrs Y for the period 16 January 2020 to 10 March 2020 at a total cost of £4494.30.

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Analysis

18. The Care Act guidance says councils should be clear and transparent so people know what they will be charged.
19. Mr X says that the Council did not inform him that the care and support provided to his mother could be chargeable. However, the evidence shows that the possibility of a financial contribution was discussed with Mr X in December 2019. Mr X says he does not recall finances being discussed with him, but the documentary evidence provided by the Council shows he signed the initial financial assessment form which explained possible charges. There is no evidence the Council gave Mr X any financial information at the time.
20. When a care and support package has been agreed, the social worker should refer the case to the finance team to complete a financial assessment. There is no set time limit in which the Council must complete a financial assessment. Statutory guidance says the Council must carry out a financial assessment of what a person can afford to pay and, once complete, it must give a written record of the assessment to the person. We would expect a council to complete a financial assessment as quickly as possible to avoid people being faced with large and unexpected bills.
21. There is no evidence the Council referred Mrs Y’s case to the finance team following the review in December 2019. The case was not referred for a financial assessment until 10 February 2020. I consider it was reasonable for the Council to have asked Mr X to complete a financial assessment before the care package commenced. Had the Council sent Mr X the financial assessment sooner, then it is likely on the balance of probabilities that Mr X would have been prompted to the cancel the care sooner.
22. I consider the delay by the Council in requesting a financial assessment contributed to Mr X not cancelling the care in January 2020. As a result of this fault, Mrs Y received a large bill the family had not been expecting. However, the Council has a legal duty to charge people for care. Mrs Y did receive care for the period in question and Mr X was sent a financial assessment to complete on 13 February 2020. Mr X could have asked the Council to cancel the care from this date, but he did not do so until 4 March 2020.
23. To rectify this, I consider it is appropriate and proportionate for the Council to waive the costs for the period 16 January 2020 to 13 February 2020.
24. The Council would have had to carry out a review of Mrs Y’s care before cancelling the care package. Therefore, it is not at fault for not cancelling the care package immediately on Mr X’s contact of 4 March 2020.

Agreed action

25. Within one month of my final decision the Council agreed to:
1. Apologise to Mr X and Mrs Y for the faults identified in this statement.
2. Waive the care costs for the period 16 January 2020 to 13 February 2020 to acknowledge the delay in requesting a financial assessment. The Council will send a new invoice to Mrs Y for the remaining charges.
3. Remind staff of the importance of requesting a financial assessment in a timely manner.

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Final decision

26. There was fault by the Council leading to injustice. The Council has agreed to my recommendations to remedy the injustice caused. I have completed my investigation on this basis.

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Investigator's decision on behalf of the Ombudsman