Summary: Ms X complained about the care her mother received from two care agencies commissioned by the Council. She also complained she was not told about the costs involved in her mother’s support. She said that if she had been, she would have stopped the care earlier. We found there was fault by the Council in not telling Ms X about an increase in the cost of her mother’s care, which resulted in an outstanding debt to the Council. The Council has agreed to apologise to Ms X for the distress this caused and pay her a financial remedy. It will also share the lessons learned with its staff.

The complaint

1. The complainant, whom I shall call Ms X, complained on behalf of her (late) mother, whom I shall call Ms M. Ms X had Power of Attorney to make decisions about her mother’s finances. Ms X complained that the Council:
• Failed to tell her that her mother would have to pay for the residential respite care she received. Instead, the Council said it would part fund this and only told her about having to pay a top up.
• Only spoke to her brother about this. If the Council had told her (as the POA) that her mother would have to pay the total costs of the respite stay, she would not have agreed to it.
• Failed to tell her, in a timely manner, about the increase in the cost of her mother’s homecare package in August 2019. If she had known about this at the time, she would have ended the care package earlier than February 2020 (when she was told about this).
• The care provided between August 2019 and March 2020, by the two care providers commissioned by the Council, was unsatisfactorily.

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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. 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)
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 considered the information I received from Ms X and the Council. I shared a copy of my draft decision with Ms X and the Council and considered any comments I received, before I made my final decision.

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What I found

Relevant legislation and guidance

6. The Care Act and its accompanying Guidance says that Councils can choose whether to charge for care. Where a council decides to charge, it must ensure the client is aware of the costs they are expected to pay in a timely manner. This enables them to make informed decisions about how they want their care to be arranged.
7. If a client has more than £23,250 in capital, they will have to pay for the entire cost of their homecare.

The complaint about respite care (charging)

8. Since March 2019, Ms X had a PoA to deal with her mother’s finances. Her mother had capital above £23,250 and was therefore responsible to pay for all the cost of her care support.
9. In July 2019, Ms M had a few falls in a short time. As such, the family told the Council it would like Ms M to go into a care home for a period of respite care. Ms X told the Council on 5 July that her brother would visit their mother daily. She also asked to be the first point of contact, because: “she is good at keeping her brother and sister updated about Ms M”. Ms X says the Council arranged the respite, but:
• Failed to inform her (the PoA) that her mother would have to pay for all the costs of the residential respite care she would receive. Instead, the Council said the family would only have to pay for the top up and the Council would pay the rest.
• The Council discussed these issues with her brother, instead of with her as her mother’s PoA.
10. Ms X says that, if the Council had told her that her mother would have to pay the total costs of the respite stay, she would not have agreed to it.
11. The Council investigated Ms X’s complaint and told her that its records show that the family was concerned for her mother’s welfare in July 2019, following repeated falls at home (at night) and an increase in her confusion. As such, the family wanted the Council to organise a period of respite care. The social worker had a conversation with Ms X’s brother on 9 July. The record states: “I asked if he had a preferred area and explained the charges as his mum was self-funding”.
12. The social worker called Ms X’s brother again on 11 July 2019. The record states that: “I explained all the costs and that the room was £650 per week and that this would be full cost to Ms M as she was self-funding”.
13. The Council says Ms X’s brother confirmed to the social worker that he had “spoken to his sisters”. It is therefore likely Ms X would have known about what had been discussed so far.
14. Ms X sent me a copy of an email she received from her brother on 11 July 2019. It said he had spoken to the social worker who said: most or all costs would be covered by the Council (maybe a top up required).

Analysis

15. Ms X was Ms M’s PoA and asked the Council to be her mother’s first point of contact. As such, the Council should have discussed these (financial) issues with her, rather than with her brother. This is fault. However, Ms X was aware of these discussions with her brother and would have had the opportunity to subsequently take over these discussions, if she had wished to do so.
16. Furthermore, taking the family’s concerns into account about Ms M’s recent falls and increased confusion, there is insufficient evidence to conclude Ms M’s family would not have gone ahead with the residential respite care the family felt she needed, based on cost considerations.
17. The records indicate that Ms X had capital savings above £23,250, which meant that she would have to pay for the full cost of her care. The records also show the Council told the family what the costs of the placement would be and what Ms M would have to pay as a self-funder.

The complaint about charging (the increase in cost of the homecare package)

18. Ms M’s care support package had been very small (one hour a week). As a result, she had only been charged £15,80 a week, for which she paid via direct debit. However, Ms M’s needs increased, which resulted in a significant increase in her support package to four visits a day, after she left respite care in August 2019. Ms X says:
• The Council failed to inform her, in a timely manner, that this meant her mother would have to pay more for her care (£267 per week). As she did not know about the increase, her mother’s direct debit stayed at £15,80, which resulted in a shortfall of £251 a week and a debt building up.
• If she had been told about the increase in August 2019, she would have stopped the package soon after and would have made private arrangements instead. She did this in March 2020, as soon as she found out about the costs in February 2020. The arrangement she put in place, which involved her and her sister providing more support, was significantly cheaper than the cost of the Council’s care package. It was £100 a week instead of £300 a week.
19. Ms M’s care package changed from care provider X to care provider Y in November 2019. Ms X says the Council failed to tell her that care provider Y’s hourly rate was £24 an hour, which was much more than the £15,80 she had paid to care provider X.
20. The Council told the family in February 2020 that it had made a mistake by failing to tell them there had been an increase in Ms M’s care costs. This meant that Ms M had accumulated a significant debt, as she had continued to only pay £15,80 towards her care.
21. Ms X says that, due to this news, and the fact the family was unhappy with the quality of the care in general, it asked the Council to reduce the package to a shower call once a week and medication calls. However, she said provider Y was unable to provide such a package and therefore the support package arranged by the Council stopped.
22. The Council has previously acknowledged to Ms X, that there had been a delay in telling her about the increase in the cost of the package. It said that:
• Ms X should have received a ‘notification letter’ to tell her of the increase. She should have received this in December 2019.
• However, she received this in February 2020 because its “Assessment and Payments section” had a significant backlog at the time.
23. Ms X says she met with her mother’s social worker in November or December 2019 at her mother’s home, at which time the social worker provided misleading information to her, saying the Council was paying for her mother’s care. In response, the Council told me its records do not show there was such a meeting in December 2019. Furthermore, it says the social worker said she does not remember such a meeting and would not have provided such advice knowing that Ms M was a self-funder. Even if this event did take place, it would not be possible for me to conclude what was discussed or explained and how.
24. The Council told me that, as part of the complaint resolution process, it completed an ‘action plan & lessons learned’ document. The actions within that document included:
• To remind social workers that costings should be revised, and relatives informed, promptly whenever changes are made to support packages.
• The assessments and payments section introduced fortnightly meetings to discuss more complex cases.

Analysis

25. I agree with Ms X that the Council failed to tell her, in a timely manner, that the cost of her mother’s care increased from £15,80 to £267 in August 2019. This is fault, which resulted in a large debt. It also failed to tell her in November 2019 that the new care provider would be even more expensive, as it would charge £24 an hour, instead of £18 (the previous provider). This is fault.
26. The Council says it usually takes the Assessment and Payments team four months to send a ‘notification letter’, which tells a client of an increase in their costs. This is an unreasonable delay, which is fault.
27. The Council should have immediately told Ms X what the new costs would be when it increased the hours in August 2019. It should also have told her of the increase in hourly rate before care provider Y started.
28. In terms of injustice, I found there was an injustice because the delay resulted in a debt, which would have been distressing to Ms X and her mother. However, on the balance of probabilities, I am unable to conclude that Ms X would have decided to stop the homecare package sooner, if she had known about the costs. The reason Ms X asked for a reduction in her mother’s care support in January 2020, was because her sister would stay with her mother for three weeks.
29. It is also not possible (yet) to determine to what extent, if at all, the care package Ms X organised after April 2020 was actually cheaper:
• Ms X has not yet provided the Council with evidence in terms of the money she has spent to employ a Personal Assistant etc after March 2020. According to information she provided to me, the costs of the PA was about £150 a week.
• The Council has told me there is additional financial information it has asked Ms X to provide, so it could calculate:
1. On what date Ms M’s capital reduced to below £23,250
2. How much Ms M would have to contribute towards her care after that date.
30. As such, the Council says that the outstanding balance remains £8,659 for the homecare and £1.377 for the respite care. Both invoices have been on hold while Ms X’s complaint has been being dealt with.

The quality of the home care provided since August 2019:

31. Ms X received four visits by care workers per day, between August 2019 and March 2020. The visits were scheduled for 0930, 1330, 1730 and 2030 and were meant to provide support with medication, washing and dressing, meal preparation and a bit of tidying. An assessment from July 2019 said that Ms M can wash her top half and would need help with dressing (putting on her top half). She could get herself a simple breakfast but ideally care workers would get her a more substantial breakfast. The assessment said she should have a shower at least twice a week, preferably at the last visit, and a good wash at night on other days.
32. Ms X said she was unhappy with the quality of the care provided by the care agencies commissioned by the Council. She said the Council upheld her complaint that the standard of care had not been good. As such, Ms S says her mother should not have had to pay for this:

The timing and duration of visits

33. Ms X said her mother did not receive visits at the correct times in the morning or did not receive this visit at all.
34. The Council reviewed the records and found:
• The start times of the first visit of the day for provider X were indeed variable. This resulted in a change of provider. However, the calls for provider Y adhered to the time within a ‘tolerance’ of approximately 30 minutes.
• Only 12 out of 357 visits by care provider X were less than 20 minutes.
• More than 90% of the visits from care provider Y were more than 20 minutes, and 125 visits were more than 30 minutes.
• It said that if there had been missed calls, causing detriment to the person being cared for, it would have considered reimbursing those calls. However, the records do not show evidence to suggest this was the case.

Ms M receiving regular showers

35. Ms X said her mother was not being showered, as she did not smell nice, and the shower looked unused. She said that she and her sister told the Council that care workers should not ask her mother if she wants a shower, as her mother will say ‘no’ to everything. Instead, they should just tell her it is shower day and explain the risks of not showering (catching a UTI etc). Ms X said that, on the occasions she herself was present, her mother always agreed to have a shower.
36. The records state that Ms X’s sister, who stayed with Ms M for a few weeks, told the Community Practitioner (CPN) at the end of August 2019, that care workers were not providing personal care. The CPN told the social worker, who said she would carry out a review after returning from leave.

Medications not being given at correct times.

37. This appears to relate to two incidents, where Ms X said that on one occasion her mother received her medication late and on one occasion not at all. Both resulted in a safeguarding incident.
38. When Ms X raised concerns about the care, the social worker contacted care provider X. The record states the social worker discussed concerns about the timing and duration of calls and medication administration, with the provider. The Council also told the care provider that care workers were opening packs of food and it was subsequently unclear what was out of date. The Council updated Ms X the same day.
39. Ms X reported at the end of September 2019 that things had not improved. The Council had been looking for a new care agency, but none had expressed an interest yet to take over the care package. Ms X said her mom would also need her first call before 9.30 as she had already gotten up by that time. The social worker asked Ms X to monitor the timings of calls and report any irregularities.
40. The Council found a new care agency at the end of October 2019. According to the Council’s records, Ms X did not raise any concerns with the Council about the care provided by agency Y, until the end of January 2020. The social worker confirmed that no concerns were raised during this time.
41. On 21 January 2020, Ms X told the Council that the care was OK, but it was not completely up to standard. She said her mother had not had a shower for two weeks and it would be best if her mother could have a shower in the evening. The care agency responded positively to Ms X’s requests and concerns, and told her:
• It organised the shower days to be Wednesday and Saturday at tea times, as requested. Care workers had been told to encourage washing and showers each day.
• Moving forwards, supervisors would be providing spot checks and regular reviews to ensure Ms M’s care needs would be met.
• Ms M refused a shower last night but did have a full body wash.
42. Following a review at the end of January 2020, the care agency said it would ask for the shower visits to be 60 instead of 30 minutes. Ms X agreed to this increase.
43. The Council said that:
• It acknowledged to Ms X that the level and standard of care was not acceptable.
• Safeguarding concerns were raised in relation to the quality and standard of care provided by provider X and provider Y.
• This did not result in a safeguarding investigation into provider X as the Council changed Ms M’s care provider.
• Case notes also reflected concerns raised in relation to documentation, general hygiene, food hygiene, timing of calls and tasks not being completed as planned.
44. The Council offered £100 to Ms X for distress and £100 for time and trouble.

Analysis

45. The Council has previously acknowledged that Ms M’s care had not always been of the required standard. Based on the information I have seen so far it appears this mainly had an impact on the following actual support Ms M received:
• Care agency X arriving late would have meant that, by that time, Ms M would have already gone up and (tried to) dress herself, and make breakfast, without the help of the care workers she needed.
• Showering: If Ms M was already dressed in the morning, she would be more reluctant to have a wash. Issues around showering were regularly raised with regards to care agency X. The Council recorded in August and September 2019 that it would look into these as part of a care review, but this review did not happen, which is fault.
46. The above-mentioned lack of care resulted in distress to Ms X.

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Agreed action

47. I recommended that the Council, within four weeks of my decision:
• Pay Ms X £300 for the distress she experienced due to being told her mother was in debt, and for the distress caused by knowing / experiencing her mother’s care support falling short of the expected standards. This amount is in addition to the £100 already offered by the Council for time and trouble.
• Ensure the notification letters, in which the Assessment and Payments team officially informs clients of (an increase in) their charges, are sent within a timeframe that is in line with the expectations of the Care Act Guidance.
• Share the lessons learned with staff within its adult social care and finance teams.
48. The Council has told me it has accepted my recommendations.

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Final decision

49. For reasons explained above, I have upheld Ms X’s complaint. I am satisfied with the actions the Council will carry out to remedy this and have therefore decided to complete my investigation and close the case.

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Investigator's decision on behalf of the Ombudsman