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Warwickshire County Council (20 009 421)

Category : Adult care services > Charging

Decision : Upheld

Decision date : 10 Jun 2021

The Ombudsman's final decision:

Summary: We upheld one of Mrs X’s complaints. The Council identified her late father Mr Y needed support to complete a financial assessment form, but it failed to provide that support. This caused Mrs X avoidable distress and time and trouble because she had to deal with the matter shortly after Mr Y died. The Council will apologise and reduce the outstanding debt by £100 to remedy the injustice.

The complaint

  1. Mrs X complained Warwickshire County Council (the Council):
      1. Did not complete a financial assessment or tell her late father Mr Y about the charge until after he died
      2. Did not take appropriate action after Mr Y reported lost money.
  2. Mrs X also complained the care home (which the Council arranged and funded) allowed Mr Y to drink alcohol during his final days.
  3. Mrs X said this caused her avoidable distress and a financial loss to the estate.

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The Ombudsman’s role and powers

  1. We investigate complaints about councils and certain other bodies. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, section 25(7), as amended) The care home provided services on behalf of the Council to fulfil the Council’s duties in the Care Act 2014. If we find fault by a council-arranged care home, we would regard this as fault by the council.
  2. We normally name care homes and other providers in our decision statements. However, we will not do so if we think someone could be identified from the name of the care home or care provider. (Local Government Act 1974, section 34H(8), as amended) I have not named the care home in this complaint because there is a risk of identifying the people involved if I do.
  3. 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)

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How I considered this complaint

  1. I considered Mrs X’s complaint to us, the Council’s response to the complaint and documents described later in this statement. I spoke to Mrs X about the complaint.
  2. Mrs X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Relevant law and guidance

  1. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (the 2014 Regulations) set out the requirements for safety and quality in care provision. The Ombudsman considers the 2014 Regulations when determining complaints about poor standards of care.
  2. Regulation 9 of the 2014 Regulations requires care and treatment to be appropriate, to meet a person’s needs and to reflect their preferences.
  3. Regulation 12(i) of the 2014 Regulations says a care provider must provide care and treatment in a safe way including by working with health professionals to ensure the health and welfare of residents.
  4. A council must carry out an assessment for any adult with an appearance of need for care and support. The assessment must be of the adult’s needs and how they impact on their wellbeing and the outcomes they want to achieve. It must also involve the individual and where appropriate their carer or any other person they might want involved. (Care Act 2014, section 9)
  5. If a council has reasonable cause to suspect abuse of an adult who needs care and support, it must make whatever enquiries it thinks is necessary to decide whether any action should be taken to protect the adult. (Care Act 2014, section 42)
  6. Actions a council takes to investigate possible abuse of an adult in need of care and support are commonly known as ‘safeguarding enquiries.’
  7. Councils may charge for care and support to meet a person’s needs. They must be transparent so people know what they will be charged. There should be enough information, support and advice available so they can understand any charge. (Care and Support Statutory Guidance, paragraphs 8.2 and 8.3)

What happened

  1. Mr Y lived in a flat and had carers from an agency visiting him daily. He became ill and went into hospital in the summer of 2019. Mrs X did not have regular contact with her father at the time and lived in a different area.
  2. The finance team’s records indicate a finance officer called Mr Y in August to speak about a financial assessment. The Council’s records indicate the officer could not get hold of Mr Y by phone and the number on the records was not Mr Y’s. So the telephone appointment did not progress.
  3. At the start of September, the social worker told the finance team that Mr Y was in and out of hospital and would need support with completing the financial assessment form. Mr Y’s social worker said she would contact the financial assessment team when she came back from her holiday. There is no record of further contact between the social worker and the finance team.
  4. The social worker assessed Mr Y’s needs in October 2019. Mr Y was in hospital. He had advanced cancer and dementia. The assessment noted:
    • Ward staff considered Mr Y had mental capacity to make decisions about his care
    • He was at risk of self-neglect because he was unrealistic about how independent he was. He had depression and was reluctant to accept care
    • Mrs X was consulted and was concerned Mr Y would not cope if he was discharged home. She said his flat was in a terrible state. She felt he needed 24-hour care
    • He was eligible for care and support
    • A referral for a financial assessment had been made. The social worker was unclear about Mr Y’s income or savings.
  5. The social worker who assessed Mr Y told me she found him very depressed and said he wanted to be left alone.
  6. The Council arranged for Mr Y to go into a care home in October 2019. The care home’s care plan said Mr Y’s GP advised he could drink alcohol as long as he was in bed.
  7. The finance team posted a financial assessment form to Mr Y to complete with a covering letter explaining what he needed to do. The letter said to contact the finance team if any difficulty completing the form.
  8. In November, the finance team sent Mr Y invoices for his care at the full cost.
  9. At the end of November, Mr Y’s friend called the finance team, with his permission. He had received a bill for his care. Mr Y asked for a new financial assessment form to be sent to him at the care home and the friend said they would help him to complete it. The finance team sent a form out to Mr Y. There is no evidence on file suggesting Mr Y or his friend returned the form.
  10. Records indicate the care home reported missing money to the Council as a safeguarding concern in December 2019. The safeguarding report said:
    • Staff at the care home reported Mr Y had over £100 when he moved in.
    • He did not allow staff to count the money or put it in the safe
    • He refused to let staff search his room to look for the money.
  11. A social worker visited Mr Y at the care home to speak to him about the money. She noted he had mental capacity to decide what to do about the money and he told her he wanted no further action taken. The social worker suggested Mr Y put his bank card and wallet in the care home’s safe and he agreed this would reduce the risk of further loss.
  12. Mrs X got in touch with the finance team in the middle of January 2020, shortly after Mr Y died. The finance team posted out a further form with a covering letter expressing condolences. Mrs X returned the form at the end of January.
  13. The finance team sent Mrs X a financial assessment with a calculation of Mr Y’s charge within two weeks of receiving the form. This reduced the invoice, but there was still about £1500 in unpaid care fees.
  14. Mrs X complained to the Council at the end of October 2020. The Council responded at the start of December saying:
    • A planned financial assessment visit did not go ahead in August 2019 and so the finance team posted a form for Mr Y to complete
    • Mr Y did not complete the form due to frequent hospital admissions. His friend rang at the end of November to ask for another form and said they would support him to complete it. This did not happen so the Council charged Mr Y the full cost of his care
    • She asked for a form in the middle of January, the finance team completed an assessment and wrote to her in the first week of February with the outcome
    • There was no record on the system of Mrs X asking for a financial assessment before her contact in January
    • Mr Y had mental capacity to decide about his care, but had poor insight. Everyone agreed he was at risk of self-neglect if he went home
    • From the information available, there was enough money in the estate left to pay the invoice
    • She had not complained about the care home.
  1. The Council told me Mr Y was in and out of hospital in September and October and when he came out of hospital into temporary care, the financial assessment was not the priority. The Council’s view is that chasing people for finance forms when they are unwell can create unnecessary conflict and distress. The Council also told me it had written off some charges already.

Was there fault and if so, did this cause injustice?

The Council did not complete a financial assessment or tell her late father Mr Y about the charge until after he died

  1. There was fault by the Council. Mr Y’s social worker told the finance team he would need support to complete the financial assessment form. So the finance team and social worker should have liaised with each other to rearrange the telephone appointment that did not go ahead in August 2019. I note the Council did not have a working phone number for Mr Y, but his whereabouts was known (hospital/home/care home) and so contact could have been established. The failure to rearrange meant Mr Y did not get the identified support to complete the paperwork. This was not in line with paragraph 8.2 and 8.3 of Care and Support Statutory Guidance. I do not share the Council’s view that chasing people early for the financial assessment paperwork is inappropriate. This is because people have to pay for their care and while completing paperwork is stressful for some, receiving a large, unexpected bill also causes stress.
  2. I note Mr Y’s friend got in touch at the end of November and the finance team checked with him first before sending out a further form. There was no fault in this.
  3. Having identified a need for support with the paperwork, the finance team should have contacted Mr Y again to see if his friend had helped him or of not, to establish whether he needed assistance. It did not do so. This was poor customer service and was fault.
  4. Once Mrs X got in touch in January and returned the paperwork, the finance team acted promptly and assessed Mr Y’s contribution. There was no fault in completing the financial assessment and adjusting the charge once the Council had all the details about Mr Y’s finances available.
  5. The lack of support from the Council in completing the financial paperwork meant Mrs X had to deal with the matter after her father’s death. This caused her avoidable distress and time and trouble.

The Council did not take appropriate action after Mr Y reported lost money.

  1. I am satisfied the Council considered the allegations under safeguarding procedures and in line with section 42 of the Care Act 2014 and there was no fault. The social worker sought Mr Y’s views and when he said he did not want further action taken, the matter was closed. The social worker gave Mr Y advice on how to minimise the chance of future financial abuse. This was appropriate and there was no fault.

The care home allowed Mr Y to drink alcohol during his final days.

  1. There was no fault by the care home which acted for the Council. Drinking alcohol was Mr Y’s wish. The care home acted in line with Regulations 9 and 14 of the 2014 Regulations by acting in line with his preferences and seeking medical advice from the GP who confirmed Mr Y was safe to drink alcohol.

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Agreed action

  1. To remedy the avoidable distress and time and trouble to Mrs X caused by the failure to support Mr Y to complete a financial assessment form, the Council:
    • Apologises to Mrs X
    • Reduces the invoice by an additional £100
  2. It should do so within one month of my final decision.
  3. There are no grounds for me to waive the bill for Mr Y’s care because he benefited from a service which the Council was entitled to charge for and so the Council is entitled to ask the estate to pay the bill.

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Final decision

  1. I upheld one of Mrs X’s complaints. The Council identified her late father Mr Y needed support to complete a financial assessment form, but it failed to provide that support. This caused Mrs X avoidable distress and time and trouble because she had to deal with the matter shortly after Mr Y died. The Council will apologise and reduce the invoice by £100.
  2. I have completed the investigation.

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Investigator's decision on behalf of the Ombudsman

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