Summary: Mr B complained that the Council recommended his mother, Mrs C, attend a day centre but did not explain that she would be required to pay for this. He says the Council also failed to complete a re-assessment of her needs. We found the Council was at fault in that it failed to send financial information to Mr B’s address and delayed in completing a financial assessment. The Council acted appropriately by completing a telephone review in February 2020 but failed to respond to Mr B’s request for a re-assessment in September 2020. In recognition of the injustice caused, the Council has agreed to apologise to Mr B and make a payment.

The complaint

1. Mr B complains on behalf of his mother, Mrs C, that the Council:
• recommended she attend a day centre but did not explain that she would be required to pay for this. The family believed it was funded by the Council; and
• failed to complete a re-assessment of Mrs C’s needs.
2. Mr B says the Council’s failings have caused a great deal of stress and he has been put to significant time and trouble in pursuing the matter.

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The Ombudsman’s role and powers

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)
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 all the information provided by Mr B, made enquiries of the Council and considered its comments and the documents it provided.
6. Mr B 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

Assessment

7. Sections 9 and 10 of the Care Act 2014 require local authorities to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to all people regardless of their finances or whether the local authority thinks an individual has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved.

Eligibility

8. The Care and Support (Eligibility Criteria) Regulations 2014 sets out the eligibility threshold for adults with care and support needs and their carers. The threshold is based on identifying how a person’s needs affect their ability to achieve relevant outcomes, and how this impacts on their wellbeing. To have needs which are eligible for support, the following must apply:
• The needs must arise from or be related to a physical or mental impairment or illness.
• Because of the needs, the adult must be unable to achieve two or more of the following:

• Managing and maintaining nutrition;
• Maintaining personal hygiene;
• Managing toilet needs;
• Being appropriately clothed;
• Being able to make use of the adult’s home safely;

• Maintaining a habitable home environment;
• Developing and maintaining family or other personal relationships;

• Accessing and engaging in work, training, education or volunteering;
• Making use of necessary facilities or services in the local community including public transport, and recreational facilities or services; and
• Carrying out any caring responsibilities the adult has for a child.

• Because of not achieving these outcomes, there is likely to be, a significant impact on the adult’s well-being.
3. Where a local authority has decided a person has eligible needs, it must meet those needs. When a local authority has decided a person is or is not eligible for support it must provide the person to whom the determination relates (the adult or carer) with a copy of its decision.

Reviews

10. Under section 27 of the Care Act 2014 there is an expectation that a local authority should conduct a review of a care and support plan at least every 12 months. It should also conduct a review if the adult or a person acting on their behalf asks for one, unless it is reasonably satisfied that the plan remains sufficient, or the request is frivolous or based on inaccurate information.

Charging for social care services

11. 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)
12. Councils must assess a person’s finances to decide what contribution he or she should make to a personal budget for care. Charges should not reduce a person’s income below a certain level (Income Support +25%). The Council can take a person’s capital and savings into account subject to certain conditions.

Key facts

13. Mr B’s mother, Mrs, C has dementia and lives alone. Mr B holds joint power of attorney with his brother for her health and welfare and finances.
14. In April 2019 Mr B contacted social services requesting a care needs assessment for Mrs C. He said that, although he did her shopping and cleaning, she needed help with washing, dressing and prompting to take her medication and eat her meals.
15. Mrs C was assessed by a social worker, Officer X, in June 2019. Mr B’s brother was present at the assessment. Officer X suggested Mrs C would benefit from attending a day centre once a week to help with social isolation and to promote her well-being and, if she liked it, this could be increased to twice a week. She assessed that Mrs C was independent with most aspects of her daily living tasks and had no other eligible needs.
16. The Council made the necessary arrangements and Mrs C began attending the day centre in mid July 2019. Mrs C enjoyed it and began attending twice a week in September 2019.
17. On 22 October 2019, the charging team telephoned Mr B to arrange a financial assessment. He asked for the financial assessment letter to be sent to him and this was posted the same day. Mr B did not return the completed form but contacted the finance team on 28 November 2019 to ask why such detailed financial information was required when his mother was only attending a local day centre twice a week. He considered the document to be highly intrusive and said it would be very time-consuming to find all the information. A finance officer explained why the information was necessary. Mr B was happy with the explanation and agreed to return the form.
18. In early January 2020, when Mr B was still in the process of completing the form, he received an invoice for £1294.38 for Mrs C’s attendance at the day centre together with transport costs. He wrote to the Council complaining that he had not previously been informed of the charges. He also complained that social services had not contacted the family since September 2019. He said “I feel mum should have a new care package assessment to determine the level of care needed.… Psychosis is starting to present itself in addition to the cognitive memory and functioning issues. There is enough evidence to make a case that mum needs help daily to function when we cannot be there”.
19. The Council acknowledged Mr B’s email and social services completed a telephone assessment on 3 February 2020. Mr B explained that Mrs C’s dementia was getting worse but confirmed she was able to wash and dress herself and needed no assistance with toileting or getting in and out of bed. He explained she mainly needed help with meal preparation and taking her medication. The officer suggested a Meals on Wheels service and Mr B said he would like details of this. It was agreed that, if this was not suitable, he would contact the Council again.
20. At the end of March 2020 Day centres closed because of COVID-19 restrictions so Mrs C’s care package was suspended.
21. Mr B wrote to the Council in April 2020 again querying Mrs C’s contribution towards the day centre costs. He received no response and chased the matter again a few weeks later. He received an email from the Council in late May 2020 apologising and stating he would receive a reply. A few days later he received an updated bill and a breakdown of the costs.
22. On 8 June 2020 Mr B complained that the Council had still not responded to his concerns about the costs. The finance team confirmed it was completing an audit of Mrs C’s account and said it had also asked social services to investigate his concerns.
23. On 26 June 2020 the finance team responded to Mr B’s complaint. It referred to a letter sent to him on 8 July 2019 which it said made it clear the day service was chargeable and that he would be contacted by the finance team to complete a financial assessment to determine Mrs C’s contribution. It acknowledged there had been a delay in arranging the financial assessment and apologised for this.
24. On 15 September 2020 Mr B wrote to the Council saying “There needs to be another assessment of Mum. She has deteriorated and no longer has the benefit of attending the Day Centre”.
25. On 5 October 2020 social services responded to Mr B’s complaint and the finance team sent him a copy of the letter dated 8 July 2019.
26. Mr B responded the same day saying he had never seen this letter before. He said that, if he had done so, he would not be complaining about the Council’s lack of communication. He again raised concerns that social services had not been in touch. He said his mother was in very poor health now and he and his brother were struggling to care for her. He said they were arranging carers to help during the week.
27. The finance team again apologised for the delay in arranging the financial assessment and said Mr B’s recent letter had been passed to social services.

Analysis

Day centre

28. Mr B says he was never told that Mrs C would be liable for the costs of the day centre. He says that, if he had been, he would have considered other options because the cost of two sessions at the day centre amounted to a quarter of her income.
29. Officer X says she told Mr B’s brother at the assessment that Mrs C’s contribution would be based on a financial assessment which would be completed by the finance team. There is no documentary evidence to support this.
30. Mr B says Officer X told him that funds had been authorised for his mother to attend the day centre two days a week. This appears to have caused some confusion. Officer X was simply informing Mr B that his request for a second day care session had been authorised by her manager, not that the Council had agreed to fund this. Mrs C’s contribution towards the cost of this had not been assessed at that point. Officer X’s responsibility is only to complete a care needs assessment to identify the level of support required to meet the service user’s needs. It is then for the finance team to complete a financial assessment and calculate the service user’s contribution towards the cost of their care.
31. The letter sent to Mr B at his mother’s address on 8 July 2019 set out the cost of the day centre and transport. It stated, “This is not a bill-it is for guidance only at this point as you will have a more detailed financial assessment to establish the actual amounts you may need to contribute”. It went on to say, “the finance team will book an appointment within the next four weeks to visit you. They will look at your financial situation in more detail and advise you of… the contribution that you will have to pay”. The letter also confirmed any contribution would be backdated to the day the services began.
32. It is clear from this letter that Mrs C may have to pay towards the cost of the day centre. However, Mr B says he did not receive this letter.
33. The Council sent the letter to Mr B at his mother’s address. Mr B has power of attorney for finances so the Council should have written to him at his address unless he specifically requested otherwise. There is a conflict of evidence about what was agreed at the assessment. Mr B says his brother told Officer X that, because of her dementia, Mrs C would often hide letters and so asked her to send any correspondence to Mr B rather than to Mrs C’s address. Officer X says Mr B’s brother told her to send correspondence to Mr B at his mother’s address because she often hid letters.
34. On a balance of probabilities, I prefer Mr B’s version of events. I consider it more likely than not that Mr B’s brother asked Officer X to write to Mr B at his own address rather than at Mrs C’s address given that she often hid post because the whole purpose of writing to Mr B was to avoid this situation. So, I find the Council was at fault in failing to write to Mr B at his own address.
35. I also find the Council was at fault in that it delayed in completing a financial assessment. The letter of 8 July 2019 stated that the finance team would contact Mr B within four weeks but it did not do so until October 2019, three months after Mrs C began attending the day centre.
36. But for the Council’s failings, Mr B would have been aware that Mrs C may have to contribute towards the cost of the day centre and would not have been in the position of receiving an unexpected bill for over £2000 in January 2020. He would also have had the opportunity to decide whether to continue with the day centre or make alternative arrangements.
37. I do not consider it appropriate to recommend that the Council refunds the cost of the day service because Mrs C has had the benefit of it. But I consider the Council should make a payment to Mr B in recognition of the distress and inconvenience he suffered.

Review of Mrs C’s care needs

38. Mr B says the Council has not made any contact with Mrs C or the family to complete a review of her care and support needs despite several requests.
39. Under the Care Act 2014, the Council should complete a review at least every 12 months or earlier if requested to do so by the service user or someone acting on their behalf.
40. Mr B first requested a re-assessment in January 2020 saying Mrs C’s needs had increased. The Council acted appropriately by completing a telephone assessment and concluded Mrs C needed help with meal preparation and recommended a meals on wheels service. It was agreed Mr B would contact the Council again if this was not sufficient.
41. Mr B contacted the Council again in September and October 2020 saying Mrs C’s health deteriorated and she needed another assessment. The Council should have completed a reassessment in response to these requests. Failure to do so was fault.
42. I am satisfied Mrs C suffered no significant injustice because of the Council’s failure to complete a re-assessment. Mr B and his brother were meeting her needs and ultimately arranged a privately funded care package. So she was getting the support she needed. In addition, it is not certain what the outcome of a review would have been if one had been completed. However, Mr B suffered a significant injustice because the failure to respond to his request for a re-assessment caused him distress and he was put to time and trouble in pursuing the matter with the Council and in arranging a private care package for Mrs C.

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Agreed action

43. The Council has agreed that, within one month of the Ombudsman’s final decision, it will apologise to Mr B and pay him:
• £250 in recognition of the distress and inconvenience caused by failing to send the July 2019 letter to his address and the delay in completing the financial assessment; and
• £250 in recognition of the distress and time and trouble he was caused by the Council’s failure to respond to his request for a review of Mrs C’s care and support needs in September 2020.

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Final decision

44. I uphold Mr B’s complaint.
45. I have completed my investigation on the basis that the Council has agreed to implement the recommended remedy.

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Investigator's decision on behalf of the Ombudsman